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General NPI Number Information
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NPI Number | 1861889735
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Entity Type | Organization
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Legal Business Name | MARIPOSA PHARMACY LTD
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Dates
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Enumeration Date | 04/18/2015
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Last Update Date | 04/18/2015
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Provider Practice Location Address
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Address Line | 2970 W OLYMPIC BLVD # 104
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City | LOS ANGELES
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State | CA
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Zip | 90006-2518
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Country | US
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Telephone | 213-365-5067
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Fax |
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Provider Business Mailing Address
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Address Line | 2970 W OLYMPIC BLVD # 104
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City | LOS ANGELES
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State | CA
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Zip | 90006-2518
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Country | US
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Telephone | 213-365-5067
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BILL PARK
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Credential |
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Telephone | 310-720-1237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY52570
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License Number State | CA
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