Healthcare Provider Details

I. General information

NPI: 1326030776
Provider Name (Legal Business Name): MONTEBELLO PHARMACY,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2005
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 W WHITTIER BLVD
MONTEBELLO CA
90640-4735
US

IV. Provider business mailing address

817 W WHITTIER BLVD
MONTEBELLO CA
90640-4735
US

V. Phone/Fax

Practice location:
  • Phone: 323-722-3200
  • Fax: 323-722-3540
Mailing address:
  • Phone: 323-722-3200
  • Fax: 323-722-3540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHA41430
License Number StateCA

VIII. Authorized Official

Name: MR. LEN SHLAIN
Title or Position: PRESIDENT
Credential:
Phone: 323-722-3200