1326768144 NPI number — BELLWOOD SPECIALTY PHARMACY CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326768144 NPI number — BELLWOOD SPECIALTY PHARMACY CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLWOOD SPECIALTY PHARMACY CORP
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:
Provider Other Organization Name Type Code:
6
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:
1326768144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10230 ARTESIA BLVD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLFLOWER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90706-6768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-714-6440
Provider Business Mailing Address Fax Number:
562-377-7952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10230 ARTESIA BLVD STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLFLOWER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90706-6768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-714-6440
Provider Business Practice Location Address Fax Number:
562-377-7952
Provider Enumeration Date:
08/31/2022

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
562-714-6440

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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