MEDICARE: PASEO RX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	3336S0011X	Specialty Pharmacy	54471	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2121732	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093702763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASEO RX INC

Provider Business Mailing Address
First Line	:	1717 E WALNUT ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1611
Country	:	US
Telephone Number	:	626-798-6789
Fax Number	:	626-798-8376

Provider Business Practice Location Address
First Line	:	1717 E WALNUT ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1611
Country	:	US
Telephone Number	:	626-798-6789
Fax Number	:	626-798-8376

Authorized Official
Title or Position	:	OWNER/PIC
Name	:	DANIEL FENG
Credential	:	PHARM.D
Telephone Number	:	626-798-6789

Provider Enumeration Date	:	09/28/2005
Last Update Date	:	03/01/2017

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Directions to “PASEO RX INC ” Practice Location

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