Provider Demographics
NPI:1831500446
Name:GRAND PHARMACY., INC
Entity Type:Organization
Organization Name:GRAND PHARMACY., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOON TAE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-276-9090
Mailing Address - Street 1:505 S VIRGIL AVE
Mailing Address - Street 2:107
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1406
Mailing Address - Country:US
Mailing Address - Phone:213-380-5100
Mailing Address - Fax:213-386-7733
Practice Address - Street 1:505 S VIRGIL AVE
Practice Address - Street 2:107
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1406
Practice Address - Country:US
Practice Address - Phone:213-380-5100
Practice Address - Fax:213-386-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY518303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy