Healthcare Provider Details

I. General information

NPI: 1033155403
Provider Name (Legal Business Name): ARTESIA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11090 ARTESIA BLVD STE H
CERRITOS CA
90703-2545
US

IV. Provider business mailing address

11090 ARTESIA BLVD STE H
CERRITOS CA
90703-2545
US

V. Phone/Fax

Practice location:
  • Phone: 562-468-4311
  • Fax: 562-468-4314
Mailing address:
  • Phone: 562-468-4311
  • Fax: 562-468-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY41551
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RONALD MILLER
Title or Position: PRESIDENT PHARMACIST
Credential:
Phone: 562-468-4311