Palisades Compounding Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

48986 Issued in CA

Legal business name

PALISADES COMPOUNDING PHARMACY INC

Doing business as

Palisades Compounding Pharmacy

Practice address

540 Palisades Dr
Pacific Palisades, CA 90272-2844

Phone

(310) 454-4848

Fax

(310) 454-3838

NPI assigned

Mar 14, 2008

Last updated

Nov 25, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shahram Soroudi

Title

President, Owner

Phone

(310) 777-2000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PALISADES COMPOUNDING PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1871764134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 PALISADES DR",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902722844",
            "telephone_number": "310-454-4848",
            "fax_number": "310-454-3838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 PALISADES DR",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902722844",
            "telephone_number": "310-454-4848",
            "fax_number": "310-454-3838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALISADES COMPOUNDING PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-14",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "SOROUDI",
        "authorized_official_first_name": "SHAHRAM",
        "authorized_official_title_or_position": "PRESIDENT, OWNER",
        "authorized_official_telephone_number": "310-777-2000"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "48986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2113288",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PALISADES COMPOUNDING PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Patrick C Park, DDS

• Community/Retail Pharmacy in Pacific Palisades, CA
• Providers in Pacific Palisades, 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 Nov 25, 2014; 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.