1184860801 NPI number — FOBI COMPREHENSIVE PHARMACY INC

Table of content: (NPI 1184860801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184860801 NPI number — FOBI COMPREHENSIVE PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOBI COMPREHENSIVE PHARMACY 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:
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:
1184860801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1990
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOMITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90717-5990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-630-5700
Provider Business Mailing Address Fax Number:
562-630-5705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7922 ROSECRANS AVE
Provider Second Line Business Practice Location Address:
STE P2
Provider Business Practice Location Address City Name:
PARAMOUNT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90723-6009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-630-5700
Provider Business Practice Location Address Fax Number:
562-630-5705
Provider Enumeration Date:
12/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FOBI
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
323-731-8414

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  489288 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5633222 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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