Healthcare Provider Details

I. General information

NPI: 1104800457
Provider Name (Legal Business Name): PASEO PHARMACY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 E COLORADO BLVD B104
PASADENA CA
91107-3650
US

IV. Provider business mailing address

2237 E COLORADO BLVD B104
PASADENA CA
91107-3650
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-1000
  • Fax: 626-583-8833
Mailing address:
  • Phone: 626-564-1001
  • Fax: 626-583-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY 51907
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY 51907
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 51907
License Number StateCA

VIII. Authorized Official

Name: MR. ANDRE SAROUGHIAN
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 626-564-1000