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General NPI Number Information
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NPI Number | 1033678248
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Entity Type | Organization
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Legal Business Name | KOAM PHARMACY LTC INC
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 18102 PIONEER BLVD STE 102
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City | ARTESIA
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State | CA
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Zip | 90701-4400
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Country | US
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Telephone | 562-402-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 18102 PIONEER BLVD STE 102
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City | ARTESIA
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State | CA
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Zip | 90701-4400
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Country | US
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Telephone | 562-402-4922
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Fax | 562-402-0671
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Authorized Official
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Title or Position | CEO
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Name | KWANG JA KIM
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Credential |
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Telephone | 562-402-4922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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