=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124196803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. JEFFREY A. BARRIS A PROFESSIONAL PHARMACY CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 02/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23560 MADISON ST STE 112
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-4709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-530-0831
-----------------------------------------------------
Fax | 310-530-8218
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23560 MADISON ST STE 112
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-4709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-530-0831
-----------------------------------------------------
Fax | 310-530-8218
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES.
-----------------------------------------------------
Name | JEFFERY BARRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-530-0831
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH 26609
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------