Healthcare Provider Details

I. General information

NPI: 1144304304
Provider Name (Legal Business Name): CALIFORNIA MEDICAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 W TEMPLE ST
LOS ANGELES CA
90026-4917
US

IV. Provider business mailing address

2201 W TEMPLE ST
LOS ANGELES CA
90026-4917
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-2343
  • Fax: 213-413-1354
Mailing address:
  • Phone: 213-413-2343
  • Fax: 213-413-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number120429
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY12414
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY12414
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHY12414
License Number StateCA

VIII. Authorized Official

Name: THOMAS J LIAUTAUD
Title or Position: PRESIDENT
Credential: RPH
Phone: 213-413-2343