1235462490 NPI number — WEST COAST PHARMACY GROUP INC

Table of content: (NPI 1235462490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235462490 NPI number — WEST COAST PHARMACY GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST COAST PHARMACY GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FLORENCE PHARMACY AND MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235462490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1422 E FLORENCE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90001-1937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-277-9500
Provider Business Mailing Address Fax Number:
323-277-9550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1422 E FLORENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90001-1937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-277-9500
Provider Business Practice Location Address Fax Number:
323-277-9550
Provider Enumeration Date:
09/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LY
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
323-277-9500

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY50748 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHY50748 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2132324 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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