Healthcare Provider Details

I. General information

NPI: 1568821833
Provider Name (Legal Business Name): KUMARX PHARMACY APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 S DELACEY AVE #1000
PASADENA CA
91105
US

IV. Provider business mailing address

155 S DELACEY AVE #1000
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 626-844-5000
  • Fax:
Mailing address:
  • Phone: 626-844-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY53832
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAHUL KUMAR
Title or Position: OWNER
Credential:
Phone: 626-844-5000