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General NPI Number Information
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NPI Number | 1508921891
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Entity Type | Organization
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Legal Business Name | CONCOURSE RX PHARMACY INC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 18575 E. GALE AVE. #158
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91748
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Country | US
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Telephone | 626-965-5988
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Fax | 626-965-6588
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Provider Business Mailing Address
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Address Line | 18575 E. GALE AVE. #158
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91748
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Country | US
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Telephone | 626-965-5988
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Fax | 626-965-6588
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Authorized Official
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Title or Position | CEO/CFO/SEC./DIR.
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Name | TIFFANY WU
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Credential |
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Telephone | 626-965-5988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY46886
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License Number State | CA
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