Healthcare Provider Details

I. General information

NPI: 1467431791
Provider Name (Legal Business Name): SOUTH WESTERN PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 S WESTERN AVE
LOS ANGELES CA
90047-2254
US

IV. Provider business mailing address

7301 S WESTERN AVE
LOS ANGELES CA
90047-2254
US

V. Phone/Fax

Practice location:
  • Phone: 323-752-1692
  • Fax: 323-752-0710
Mailing address:
  • Phone: 323-752-1692
  • Fax: 323-752-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48238
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY 32368
License Number StateCA

VIII. Authorized Official

Name: MS. MARTHA TUMBAN
Title or Position: OWNER
Credential:
Phone: 323-752-1692