Healthcare Provider Details

I. General information

NPI: 1790830115
Provider Name (Legal Business Name): CHEMIQUE PHARMACEUTICALS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13306 WHITTIER BLVD
WHITTIER CA
90602-3052
US

IV. Provider business mailing address

PO BOX 4369
WHITTIER CA
90607-4369
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0921
  • Fax: 562-693-6112
Mailing address:
  • Phone: 562-698-0921
  • Fax: 562-693-6112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberLSC99027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY33091
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberLSC99027
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberLSC99027
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberLSC99027
License Number StateCA

VIII. Authorized Official

Name: DR. PHIL LOWELL MILLMAN
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 562-698-0921