Healthcare Provider Details

I. General information

NPI: 1093702763
Provider Name (Legal Business Name): PASEO RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2005
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 E WALNUT ST
PASADENA CA
91106-1611
US

IV. Provider business mailing address

1717 E WALNUT ST
PASADENA CA
91106-1611
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-6789
  • Fax: 626-798-8376
Mailing address:
  • Phone: 626-798-6789
  • Fax: 626-798-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number54471
License Number StateCA

VIII. Authorized Official

Name: DANIEL FENG
Title or Position: OWNER/PIC
Credential: PHARM.D
Phone: 626-798-6789