Provider Demographics
NPI:1124455464
Name:OLIVE HILL PHARMACY, INC.
Entity type:Organization
Organization Name:OLIVE HILL PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:YEE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:213-680-2000
Mailing Address - Street 1:255 S HILL ST # 217
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3500
Mailing Address - Country:US
Mailing Address - Phone:213-680-2000
Mailing Address - Fax:213-680-2010
Practice Address - Street 1:255 S HILL ST # 217
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3500
Practice Address - Country:US
Practice Address - Phone:213-680-2000
Practice Address - Fax:213-680-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 516143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51614OtherCALIFORNIA BOARD OF PHARMACY
CA1124455464Medicaid