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General NPI Number Information
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NPI Number | 1740343433
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Entity Type | Organization
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Legal Business Name | 1663 PHARMACY INC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1663 BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90026-5710
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Country | US
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Telephone | 213-250-7229
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Fax | 213-250-0439
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Provider Business Mailing Address
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Address Line | 1663 BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90026-5710
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Country | US
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Telephone | 213-250-7229
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Fax | 213-250-0439
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. TEODORO REYES SANTOS
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Credential |
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Telephone | 213-250-7229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 31852
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License Number State | CA
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