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General NPI Number Information
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NPI Number | 1295749760
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Entity Type | Organization
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Legal Business Name | BEACON DRUG CO. #6
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1303 N AVALON BLVD
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City | WILMINGTON
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State | CA
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Zip | 90744-2603
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Country | US
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Telephone | 310-834-3457
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Fax | 310-834-1170
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Provider Business Mailing Address
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Address Line | 1303 N AVALON BLVD
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City | WILMINGTON
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State | CA
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Zip | 90744-2603
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Country | US
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Telephone | 310-834-3457
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Fax | 310-834-1170
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Authorized Official
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Title or Position | PHARAMICIST IN CHARGE
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Name | ERIC SONG
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Credential | PHARM. D
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Telephone | 310-834-3457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY354220
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License Number State | CA
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