Healthcare Provider Details

I. General information

NPI: 1194196303
Provider Name (Legal Business Name): PASEO PHARMACY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/14/2015
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: 626-564-1001
  • Fax: 626-583-8833
Mailing address:
  • Phone: 626-564-1001
  • Fax: 626-583-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHY51907
License Number StateCA

VIII. Authorized Official

Name: MR. ANDRE SAROUGHIAN
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 626-564-1001