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General NPI Number Information
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NPI Number | 1669781043
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Entity Type | Organization
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Legal Business Name | USC I.D.S. PHARMACY
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 1441 EASTLAKE AVE STE 2407
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City | LOS ANGELES
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State | CA
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Zip | 90089-0112
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Country | US
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Telephone | 323-865-3538
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Fax | 323-865-0857
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Provider Business Mailing Address
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Address Line | 1441 EASTLAKE AVE SUITE 2407
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City | LOS ANGELES
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State | CA
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Zip | 90089-0112
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Country | US
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Telephone | 323-865-3538
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Fax | 323-865-0857
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Authorized Official
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Title or Position | C.O.O
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Name | SCOTT EVANS
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Credential |
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Telephone | 323-442-8677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY 50231
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License Number State | CA
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