Healthcare Provider Details

I. General information

NPI: 1124557434
Provider Name (Legal Business Name): LPS PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 N. HACIENDA BLVD.
LA PUENTE CA
91744-1137
US

IV. Provider business mailing address

1647 N. HACIENDA BLVD.
LA PUENTE CA
91744-1137
US

V. Phone/Fax

Practice location:
  • Phone: 626-850-5318
  • Fax: 626-850-5319
Mailing address:
  • Phone: 626-850-5318
  • Fax: 626-850-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MISS TOMY VUONG
Title or Position: PIC
Credential: PHARM.D.
Phone: 626-850-5318