Healthcare Provider Details

I. General information

NPI: 1962065706
Provider Name (Legal Business Name): MEDCARE PHARMACY AND MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 W HUNTINGTON DR STE 101
ARCADIA CA
91007-3492
US

IV. Provider business mailing address

289 W HUNTINGTON DR STE 101
ARCADIA CA
91007-3492
US

V. Phone/Fax

Practice location:
  • Phone: 626-623-6171
  • Fax: 888-258-1303
Mailing address:
  • Phone: 626-623-6179
  • Fax: 888-258-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWIN HARATONIANS
Title or Position: CEO
Credential:
Phone: 626-623-6171