=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386058956
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY CHOW PHARM D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2014
-----------------------------------------------------
Last Update Date | 06/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1421 E WASHINGTON BLVD
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91104-2650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-296-0245
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 GENOA ST UNIT B
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91006-6685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 69778
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------