Healthcare Provider Details

I. General information

NPI: 1679792766
Provider Name (Legal Business Name): INTERCARE HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 W TEMPLE ST
LOS ANGELES CA
90026-5421
US

IV. Provider business mailing address

1711 W TEMPLE ST
LOS ANGELES CA
90026-5421
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-3580
  • Fax: 213-484-3532
Mailing address:
  • Phone: 213-484-3580
  • Fax: 213-484-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberHSP43766
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAI THAI
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 213-484-3501