Provider Demographics
NPI:1801219142
Name:HOLLANDER, EDWARD JACK (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JACK
Last Name:HOLLANDER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2916
Mailing Address - Country:US
Mailing Address - Phone:323-931-3510
Mailing Address - Fax:323-938-7519
Practice Address - Street 1:152 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2916
Practice Address - Country:US
Practice Address - Phone:323-931-3510
Practice Address - Fax:323-938-7519
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31223183500000X
AZ6498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist