MEDICARE: PACIFIC COAST RX LLC

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	3336C0003X	Community/Retail Pharmacy	PHA50128	CA

General Provider Information

NPI Number	:	1578795803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC COAST RX LLC

Provider Business Mailing Address
First Line	:	7024 SEVILLE AVE STE E
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4969
Country	:	US
Telephone Number	:	323-587-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7024 SEVILLE AVE STE E
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4969
Country	:	US
Telephone Number	:	323-587-1200
Fax Number	:	323-587-1300

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AKSHAR PATEL
Credential	:
Telephone Number	:	323-587-1200

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	01/13/2026

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