Healthcare Provider Details

I. General information

NPI: 1992798698
Provider Name (Legal Business Name): BIG 1 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W VALLEY BLVD
SAN GABRIEL CA
91776-3728
US

IV. Provider business mailing address

415 W VALLEY BLVD
SAN GABRIEL CA
91776-3728
US

V. Phone/Fax

Practice location:
  • Phone: 626-281-2186
  • Fax: 626-281-3583
Mailing address:
  • Phone: 626-281-2186
  • Fax: 626-281-3583

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY43845
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVEN CHIN
Title or Position: OFFICER
Credential:
Phone: 626-281-2186