1912098732 NPI number — THE MEDICINE CABINET INC

Table of content: (NPI 1912098732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912098732 NPI number — THE MEDICINE CABINET INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MEDICINE CABINET 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:
THE MEDICINE CABINET #2
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:
1912098732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9901 PARAMOUNT BLVD STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90240-3852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
628-068-3945
Provider Business Mailing Address Fax Number:
562-776-2257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 E ANAHEIM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90744-4516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-513-9214
Provider Business Practice Location Address Fax Number:
310-513-9246
Provider Enumeration Date:
09/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SOLIMAN
Authorized Official First Name:
ASH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-806-8394

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHY 46884 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: MEDICAID . This is a "1912098732" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5614210 . This is a "NCPDP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 46884 . This is a "PHY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".