Michelle Mine NA

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY43105 Issued in CA

Legal business name

MICHELLE MINE NA

Doing business as

Siloam Pharmacy

Practice address

2528 W Olympic Blvd
Suite 102
Los Angeles, CA 90006-2922

Phone

(213) 382-0700

Fax

(213) 480-1442

NPI assigned

Jan 23, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Michelle Mine NA

Title

Pharmacist & Owner

Phone

(213) 382-0700

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Siloam Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671148800000",
    "number": "1285789248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2528 W OLYMPIC BLVD",
            "address_2": "SUITE 102",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062922",
            "telephone_number": "213-382-0700",
            "fax_number": "213-480-1442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2528 W OLYMPIC BLVD",
            "address_2": "SUITE 102",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062922",
            "telephone_number": "213-382-0700",
            "fax_number": "213-480-1442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHELLE MINE NA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A",
        "authorized_official_last_name": "NA",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "MINE",
        "authorized_official_title_or_position": "PHARMACIST & OWNER",
        "authorized_official_telephone_number": "213-382-0700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY43105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0571667",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA431050",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Siloam Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Siloam Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Michelle M Kelman DDS PC
• Michelle McCarthy Physical Therapy, Inc
• Michelle Pullum
• Jenny Michelsen
• Lauren Michelson
• William Michelson, LMFT
• Lori Ann Michener, PT, ATC

• Community/Retail Pharmacy in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.