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NPI Code Detail

MEDICARE: APOTHECARY SHOP OF LOS ANGELES INC

MEDICARE: APOTHECARY SHOP OF LOS ANGELES 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
13336S0011XSpecialty PharmacyPHY 49836CA
23336C0004XCompounding PharmacyPHY 49836CA
33336C0003XCommunity/Retail PharmacyPHY 49836CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CN874AOTHERMEDICARE PART B MASS IMMUNIZATION ROSTER BILLER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
20519263OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174693253
Entity Type Code : Organization
Provider Name (Legal Business Name) : APOTHECARY SHOP OF LOS ANGELES INC
Provider Business Mailing Address
First Line : 1606 W WHISPERING WIND DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85085-0678
Country : US
Telephone Number : 623-434-3659
Fax Number : 623-434-3673
Provider Business Practice Location Address
First Line : 325 N LARCHMONT BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-3011
Country : US
Telephone Number : 323-466-1414
Fax Number : 323-466-1333
Authorized Official
Title or Position : DIRECTOR/CEO
Name : JOHN D MUSIL
Credential : PHARMD, RPH
Telephone Number : 623-434-3657
Provider Enumeration Date : 11/08/2006
Last Update Date : 03/23/2010

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Directions to “APOTHECARY SHOP OF LOS ANGELES INC ” Practice Location

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