Healthcare Provider Details

I. General information

NPI: 1407848120
Provider Name (Legal Business Name): EL REY MEDICAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 WHITTIER BLVD
LOS ANGELES CA
90022-4015
US

IV. Provider business mailing address

5310 WHITTIER BLVD
LOS ANGELES CA
90022-4015
US

V. Phone/Fax

Practice location:
  • Phone: 323-262-9403
  • Fax: 323-262-3433
Mailing address:
  • Phone: 323-262-9403
  • Fax: 323-262-3433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHD 42096
License Number StateCA

VIII. Authorized Official

Name: MRS. SHANA MELAMED
Title or Position: OWNER
Credential: PHARM D
Phone: 310-273-1644