Healthcare Provider Details

I. General information

NPI: 1942304993
Provider Name (Legal Business Name): DISCO REX PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 UNIVERSITY AVE
PALO ALTO CA
94301-1715
US

IV. Provider business mailing address

328 UNIVERSITY AVE
PALO ALTO CA
94301-1715
US

V. Phone/Fax

Practice location:
  • Phone: 650-326-3873
  • Fax: 650-326-0403
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY33116
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YU FUN THOMAS LAI
Title or Position: PRESIDENT
Credential:
Phone: 650-326-3873