MEDICARE: SERV-U-PHARMACY 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PHY51878	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2004651	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770578981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERV-U-PHARMACY INC

Provider Business Mailing Address
First Line	:	2034 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5011
Country	:	US
Telephone Number	:	213-385-5225
Fax Number	:	213-385-5222

Provider Business Practice Location Address
First Line	:	2034 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5011
Country	:	US
Telephone Number	:	213-385-5225
Fax Number	:	213-385-5222

Authorized Official
Title or Position	:	OWNER
Name	:	ROGER TSENG
Credential	:
Telephone Number	:	213-385-5225

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	11/17/2016

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Directions to “SERV-U-PHARMACY INC ” Practice Location

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