MEDICARE: ARDMORE PHARMACY

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	PHY49804	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

General Provider Information

NPI Number	:	1588899579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARDMORE PHARMACY

Provider Business Mailing Address
First Line	:	3545 WILSHIRE BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2378
Country	:	US
Telephone Number	:	213-385-2135
Fax Number	:	213-385-2138

Provider Business Practice Location Address
First Line	:	3545 WILSHIRE BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2378
Country	:	US
Telephone Number	:	213-385-2135
Fax Number	:	213-385-2138

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINA BOH-YOUNG PARK
Credential	:	PHARMACIST
Telephone Number	:	213-385-2135

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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Directions to “ARDMORE PHARMACY ” Practice Location

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