MEDICARE: DAVIDS 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY39983	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0551184	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1598950909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIDS PHARMACY

Provider Business Mailing Address
First Line	:	3000 W OLYMPIC BLVD
Second Line	:	STE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 W OLYMPIC BLVD
Second Line	:	STE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2516
Country	:	US
Telephone Number	:	213-388-0300
Fax Number	:	213-388-5324

Authorized Official
Title or Position	:	OWNER AND PIC
Name	:	DAVID KIM
Credential	:
Telephone Number	:	213-388-0300

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	09/10/2007

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Directions to “DAVIDS PHARMACY ” Practice Location

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