MEDICARE: ZION CAPITAL INVESTMENT, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY48265	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0566161	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1245459239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZION CAPITAL INVESTMENT, INC

Provider Business Mailing Address
First Line	:	3900 W 3RD ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2675
Country	:	US
Telephone Number	:	213-382-6485
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 W 3RD ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2675
Country	:	US
Telephone Number	:	213-382-6485
Fax Number	:

Authorized Official
Title or Position	:	PHRMACIST
Name	:	JAMIE PARK
Credential	:
Telephone Number	:	213-382-4433

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	02/11/2010

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Directions to “ZION CAPITAL INVESTMENT, INC ” Practice Location

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