=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689440836
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2023
-----------------------------------------------------
Last Update Date | 01/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15262 GOLDENWEST ST
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-6169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-735-3226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15262 GOLDENWEST ST
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-6169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-735-3226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPPORT
-----------------------------------------------------
Name | KATIE VEECH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 218-340-7903
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------