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General NPI Number Information
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NPI Number | 1679792766
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Entity Type | Organization
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Legal Business Name | INTERCARE HEALTH SYSTEMS INC
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 1711 W TEMPLE ST
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City | LOS ANGELES
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State | CA
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Zip | 90026-5421
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Country | US
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Telephone | 213-484-3580
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Fax | 213-484-3532
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Provider Business Mailing Address
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Address Line | 1711 W TEMPLE ST
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City | LOS ANGELES
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State | CA
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Zip | 90026-5421
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Country | US
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Telephone | 213-484-3580
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Fax | 213-484-3532
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MAI THAI
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Credential |
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Telephone | 213-484-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | HSP43766
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License Number State | CA
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