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General NPI Number Information
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NPI Number | 1932377363
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Entity Type | Organization
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Legal Business Name | MEDICAL BASE PHARMACY/DME
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 11135 RUSH ST SUITE #H
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City | SOUTH EL MONTE
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State | CA
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Zip | 91733-3511
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Country | US
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Telephone | 626-215-2268
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Fax |
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Provider Business Mailing Address
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Address Line | 11135 RUSH ST SUITE #H
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City | SOUTH EL MONTE
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State | CA
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Zip | 91733-3511
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Country | US
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Telephone | 626-215-2268
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRINIDAD M. BAGOYO
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Credential | RPH
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Telephone | 626-215-2268
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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 | RPH 22293
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License Number State | CA
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