Healthcare Provider Details

I. General information

NPI: 1467251348
Provider Name (Legal Business Name): VIA CARE CHC-PHARMACY TWEEDY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4476 TWEEDY BLVD STE B
SOUTH GATE CA
90280-6359
US

IV. Provider business mailing address

3601 E 1ST ST
LOS ANGELES CA
90063-2325
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-9191
  • Fax: 323-268-9119
Mailing address:
  • Phone: 323-268-9191
  • Fax: 323-268-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: NINA FALCETTI
Title or Position: CHRO
Credential:
Phone: 323-268-9191