=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740336148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHEMIQUE PHARMACEUTICALS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 01/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13306 WHITTIER BLVD
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90602-3052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-698-0921
-----------------------------------------------------
Fax | 562-693-6112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4369
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90607-4369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-698-0921
-----------------------------------------------------
Fax | 562-693-6112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PHIL LOWELL MILLMAN
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 562-698-0921
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PHA33091
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------