Healthcare Provider Details

I. General information

NPI: 1063433019
Provider Name (Legal Business Name): BUY WELL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 HUNTINGTON DR
SAN MARINO CA
91108-2357
US

IV. Provider business mailing address

375 HUNTINGTON DR
SAN MARINO CA
91108-2357
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-1159
  • Fax: 626-441-9789
Mailing address:
  • Phone: 626-441-1159
  • Fax: 626-441-9789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50380
License Number StateCA

VIII. Authorized Official

Name: GIN GIN DU
Title or Position: VICE PRESIDENT
Credential:
Phone: 626-441-1159