Healthcare Provider Details

I. General information

NPI: 1871767749
Provider Name (Legal Business Name): PRIME PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 AVALON BLVD STE 2
LOS ANGELES CA
90011-5622
US

IV. Provider business mailing address

3010 WILSHIRE BLVD STE 222
LOS ANGELES CA
90010-1146
US

V. Phone/Fax

Practice location:
  • Phone: 323-432-5183
  • Fax: 323-232-9414
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY48954
License Number StateCA

VIII. Authorized Official

Name: RUSSELL SMITH
Title or Position: CFO
Credential:
Phone: 805-529-1195