Healthcare Provider Details

I. General information

NPI: 1891890158
Provider Name (Legal Business Name): LONG BEACH MEMORIAL MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806
US

IV. Provider business mailing address

PO BOX 20359
LONG BEACH CA
90801-3359
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-7948
  • Fax: 562-933-8785
Mailing address:
  • Phone: 562-933-7948
  • Fax: 562-933-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number51029
License Number StateCA

VIII. Authorized Official

Name: CHRIS FINCH
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 714-377-3218