MEDICARE: WEST COAST PHARMACY GROUP 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	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336S0011X	Specialty Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PHY50748	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2132324	OTHER		PK

General Provider Information

NPI Number	:	1235462490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST COAST PHARMACY GROUP INC

Provider Business Mailing Address
First Line	:	1422 E FLORENCE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90001-1937
Country	:	US
Telephone Number	:	323-277-9500
Fax Number	:	323-277-9550

Provider Business Practice Location Address
First Line	:	1422 E FLORENCE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90001-1937
Country	:	US
Telephone Number	:	323-277-9500
Fax Number	:	323-277-9550

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEAN LY
Credential	:
Telephone Number	:	323-277-9500

Provider Enumeration Date	:	09/04/2009
Last Update Date	:	05/26/2022

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