=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861504789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST COVINA PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 12/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1661 HANOVER RD STE 104B
-----------------------------------------------------
City | CITY OF INDUSTRY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91748-1796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-839-9882
-----------------------------------------------------
Fax | 626-839-9166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1661 HANOVER RD STE 104B
-----------------------------------------------------
City | CITY OF INDUSTRY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91748-1796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-839-9882
-----------------------------------------------------
Fax | 626-839-9166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RPH
-----------------------------------------------------
Name | CHEUK LEW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-839-9882
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY46101
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------