MEDICARE: YORK PROFESSIONAL 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	183500000X	Pharmacist		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	:	1871645507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YORK PROFESSIONAL PHARMACY

Provider Business Mailing Address
First Line	:	5821 YORK BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-2634
Country	:	US
Telephone Number	:	323-254-6839
Fax Number	:

Provider Business Practice Location Address
First Line	:	5821 YORK BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-2634
Country	:	US
Telephone Number	:	323-254-6839
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. YUHONNE THOM
Credential	:	PHARMACIST
Telephone Number	:	323-254-6839

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	12/28/2007

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Directions to “YORK PROFESSIONAL PHARMACY ” Practice Location

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