MEDICARE: FOBI COMPREHENSIVE PHARMACY 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	3336C0003X	Community/Retail Pharmacy	489288	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5633222	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1184860801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOBI COMPREHENSIVE PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 1990
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-5990
Country	:	US
Telephone Number	:	562-630-5700
Fax Number	:	562-630-5705

Provider Business Practice Location Address
First Line	:	7922 ROSECRANS AVE
Second Line	:	STE P2
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-6009
Country	:	US
Telephone Number	:	562-630-5700
Fax Number	:	562-630-5705

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM FOBI
Credential	:
Telephone Number	:	323-731-8414

Provider Enumeration Date	:	12/30/2008
Last Update Date	:	10/22/2009

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