MEDICARE: DURFEE 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	3336C0004X	Compounding Pharmacy
2	3336H0001X	Home Infusion Therapy Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	333600000X	Pharmacy
6	3336C0003X	Community/Retail Pharmacy	50152	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5638412	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1225356173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DURFEE PHARMACY INC

Provider Business Mailing Address
First Line	:	3030 S HACIENDA BLVD
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-5313
Country	:	US
Telephone Number	:	626-442-5015
Fax Number	:	626-442-7810

Provider Business Practice Location Address
First Line	:	3030 S HACIENDA BLVD
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-5313
Country	:	US
Telephone Number	:	626-442-5015
Fax Number	:	626-442-7810

Authorized Official
Title or Position	:	OWNER PIC
Name	:	RICHARD STACEY
Credential	:
Telephone Number	:	626-587-6639

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	09/29/2011

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Directions to “DURFEE PHARMACY INC ” Practice Location

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