| NPI | 1114901014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOM SHAFA Owner, PIC, AO 310-657-1635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: CA PHY22051) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| Enumeration Date | 2005-12-04 |
| Last Update Date | 2021-12-22 |