MEDICARE: WHITE CROSS PHARMACY

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	333600000X	Pharmacy	PHY 41289	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY 41289	OTHER	CA	PHARMACY

General Provider Information

NPI Number	:	1235338690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE CROSS PHARMACY

Provider Business Mailing Address
First Line	:	1412 W. GLENOAKS BLVD
Second Line	:	SUITE E
City	:	GLENDALE
State	:	CA
Zip	:	91201-1980
Country	:	US
Telephone Number	:	888-228-0555
Fax Number	:	818-986-1599

Provider Business Practice Location Address
First Line	:	1412 W GLENOAKS BLVD
Second Line	:	SUITE E
City	:	GLENDALE
State	:	CA
Zip	:	91201-1980
Country	:	US
Telephone Number	:	888-228-0555
Fax Number	:	818-986-1599

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MART ROHT
Credential	:	RPH
Telephone Number	:	888-228-0555

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	07/16/2007

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Directions to “WHITE CROSS PHARMACY ” Practice Location

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