Healthcare Provider Details

I. General information

NPI: 1306229604
Provider Name (Legal Business Name): 4 M PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2015
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE 152
PASADENA CA
91106-2411
US

IV. Provider business mailing address

960 E GREEN ST STE 152
PASADENA CA
91106-2411
US

V. Phone/Fax

Practice location:
  • Phone: 626-204-7420
  • Fax:
Mailing address:
  • Phone: 626-204-7420
  • Fax: 626-204-7417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. STEPHEN COBOS
Title or Position: PRESIDENT
Credential:
Phone: 818-464-5655