Healthcare Provider Details

I. General information

NPI: 1154433142
Provider Name (Legal Business Name): INTERNATIONAL PHARMACIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 TELEGRAPH RD
PICO RIVERA CA
90660-5424
US

IV. Provider business mailing address

9301 TELEGRAPH RD
PICO RIVERA CA
90660-5424
US

V. Phone/Fax

Practice location:
  • Phone: 562-801-0067
  • Fax: 562-801-1251
Mailing address:
  • Phone: 562-801-0067
  • Fax: 562-801-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY40996
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPHA409960
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer
# 2
Identifier1988388
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: NEGDA IVONNE DE LA ROSA
Title or Position: VICE PRESIDENT
Credential:
Phone: 562-801-0067