=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619429420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALINA ZALA INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2016
-----------------------------------------------------
Last Update Date | 10/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3737 MARTIN LUTHER KING JR BLVD #101
-----------------------------------------------------
City | LYNWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90262-3513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-438-2616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3737 MARTIN LUTHER KING JR BLVD #101
-----------------------------------------------------
City | LYNWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90262-3513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-438-2616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO/PIC
-----------------------------------------------------
Name | JITESH ZALA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-438-2616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 55265
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------