Healthcare Provider Details

I. General information

NPI: 1588675136
Provider Name (Legal Business Name): CALIFORNIA PHARMACY SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11480 BROOKSHIRE AVE STE 102
DOWNEY CA
90241-5018
US

IV. Provider business mailing address

11480 BROOKSHIRE AVE STE 102
DOWNEY CA
90241-5018
US

V. Phone/Fax

Practice location:
  • Phone: 562-861-5010
  • Fax: 562-861-5091
Mailing address:
  • Phone: 562-861-5010
  • Fax: 562-861-5091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY48784
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN TILLEY
Title or Position: PRESIDENT
Credential: RPH
Phone: 562-862-8416