Provider Demographics
NPI:1780936237
Name:EMERSON PHARMACY, INC
Entity type:Organization
Organization Name:EMERSON PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURY
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-780-2844
Mailing Address - Street 1:8400 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2416
Mailing Address - Country:US
Mailing Address - Phone:310-670-3829
Mailing Address - Fax:877-847-9589
Practice Address - Street 1:8400 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2416
Practice Address - Country:US
Practice Address - Phone:310-670-3829
Practice Address - Fax:877-847-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336M0002X, 3336S0011X
CAPHY487543336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5645467OtherNCPDP PROVIDER IDENTIFICATION NUMBER