NPIMap

Organization Active NPI

Olive Branch Pharmacy

  • Community/Retail Pharmacy
  • Los Angeles, CA
National Provider Identifier
1174997605
Registry record updated Feb 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY53627 Issued in CA
Legal business name
OLIVE BRANCH PHARMACY
Doing business as
Olive Branch Pharmacy
Practice address
2811 S San Pedro St
Los Angeles, CA 90011-2023
Phone
(323) 432-2131
Fax
(323) 432-2012
NPI assigned
Nov 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Redda Alhoussayni, PHARM.D.NPI 1801234463
Title
Owner
Phone
(323) 432-2131

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY53627 CA Primary

Addresses

Primary practice location

2811 S San Pedro St
Los Angeles, CA 90011-2023

Mailing address

2070 S Central Ave
Los Angeles, CA 90011-1235
Phone (213) 536-4888

Other identifiers 1

IdentifierTypeStateIssuer
2155055OtherPK

Other names 1

  • OLIVE BRANCH PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Olive Branch Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2811 S San Pedro St
Los Angeles, CA 90011
Phone (323) 432-2131

2070 S Central Ave
Los Angeles, CA 90011
Phone (213) 536-4888

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487721600000",
    "number": "1174997605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2070 S CENTRAL AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900111235",
            "telephone_number": "213-536-4888",
            "fax_number": "213-536-4889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900112023",
            "telephone_number": "323-432-2131",
            "fax_number": "323-432-2012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE BRANCH PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-20",
        "last_updated": "2017-02-22",
        "status": "A",
        "authorized_official_last_name": "ALHOUSSAYNI",
        "authorized_official_first_name": "REDDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-432-2131",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY53627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2155055",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OLIVE BRANCH PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.