MEDICARE: LA PHARMACIE, 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	3336C0003X	Community/Retail Pharmacy	PHY37115	CA
2	3336C0003X	Community/Retail Pharmacy

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801893466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA PHARMACIE, INC

Provider Business Mailing Address
First Line	:	1152 VIA VERDE
Second Line	:
City	:	SAN DIMAS
State	:	CA
Zip	:	91773-4401
Country	:	US
Telephone Number	:	909-599-3444
Fax Number	:	909-599-6627

Provider Business Practice Location Address
First Line	:	1152 VIA VERDE
Second Line	:
City	:	SAN DIMAS
State	:	CA
Zip	:	91773-4401
Country	:	US
Telephone Number	:	909-599-3444
Fax Number	:	909-599-6627

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEAN LY
Credential	:	PHARM.D.
Telephone Number	:	909-599-3444

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/16/2020

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Directions to “LA PHARMACIE, INC ” Practice Location

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