Provider Demographics
NPI:1063501054
Name:SHERMAN CARE ENTERPRISE,INC
Entity type:Organization
Organization Name:SHERMAN CARE ENTERPRISE,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/CFO/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHANTEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-785-6049
Mailing Address - Street 1:7218 VAN NUYS BLVD
Mailing Address - Street 2:#B
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-6800
Mailing Address - Country:US
Mailing Address - Phone:818-785-6049
Mailing Address - Fax:818-785-5907
Practice Address - Street 1:7218 VAN NUYS BLVD STE B
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-6803
Practice Address - Country:US
Practice Address - Phone:818-785-6049
Practice Address - Fax:818-785-5907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50719333600000X, 3336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY57998OtherBOARD OF PHARMACY
5624297OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA6700550001Medicare NSC