MEDICARE: SIERRA RX 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	183500000X	Pharmacist	PHY32680	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	0578700	OTHER		NABP

General Provider Information

NPI Number	:	1265422406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIERRA RX INC

Provider Business Mailing Address
First Line	:	2708 S FIGUEROA ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-3255
Country	:	US
Telephone Number	:	213-746-1828
Fax Number	:	213-746-4137

Provider Business Practice Location Address
First Line	:	2708 S FIGUEROA ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-3255
Country	:	US
Telephone Number	:	213-746-1828
Fax Number	:	213-746-4137

Authorized Official
Title or Position	:	OWNER PHARMACIST IN CHARGE
Name	:	DR. DON S GREENE
Credential	:	PHARM D
Telephone Number	:	213-746-1828

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	08/22/2020

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Directions to “SIERRA RX INC ” Practice Location

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