Healthcare Provider Details

I. General information

NPI: 1871623280
Provider Name (Legal Business Name): DIABETES CARE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 1/2 S GLENDORA AVE STE C
WEST COVINA CA
91790-3060
US

IV. Provider business mailing address

1339 W GARVEY AVE N
WEST COVINA CA
91790-2242
US

V. Phone/Fax

Practice location:
  • Phone: 626-814-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TONY SONG
Title or Position: CEO
Credential:
Phone: 626-488-0692