Provider Demographics
NPI:1750913448
Name:SHERMAN OAKS PHARMACY
Entity type:Organization
Organization Name:SHERMAN OAKS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-285-8655
Mailing Address - Street 1:14842 1/2 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1328
Mailing Address - Country:US
Mailing Address - Phone:818-285-8655
Mailing Address - Fax:818-387-6257
Practice Address - Street 1:14842 1/2 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1328
Practice Address - Country:US
Practice Address - Phone:818-285-8655
Practice Address - Fax:818-387-6257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY58638OtherBOARD OF PHARMACY