Healthcare Provider Details

I. General information

NPI: 1831299874
Provider Name (Legal Business Name): 986 SPECIALTY PHARMACY PASADENA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 E. WALNUT ST.
PASADENA CA
91106-1611
US

IV. Provider business mailing address

1719 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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. SIMON CHAN
Title or Position: VP
Credential:
Phone: 626-798-6789