Provider Demographics
NPI:1194253161
Name:KOHANBASH, GERSHON ELIEZER (PHARMD)
Entity type:Individual
Prefix:
First Name:GERSHON
Middle Name:ELIEZER
Last Name:KOHANBASH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2902
Mailing Address - Country:US
Mailing Address - Phone:310-209-9141
Mailing Address - Fax:
Practice Address - Street 1:1001 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2902
Practice Address - Country:US
Practice Address - Phone:310-209-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35289183500000X
CA78258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist