MEDICARE: PHARMACA 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	3336C0003X	Community/Retail Pharmacy	36848	CA

General Provider Information

NPI Number	:	1376091199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACA PHARMACY

Provider Business Mailing Address
First Line	:	12025 SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4922
Country	:	US
Telephone Number	:	310-476-1237
Fax Number	:

Provider Business Practice Location Address
First Line	:	12025 SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4922
Country	:	US
Telephone Number	:	310-476-1237
Fax Number	:

Authorized Official
Title or Position	:	VP PHARMACY
Name	:	MR. STU GRATZ
Credential	:
Telephone Number	:	303-867-3105

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	09/21/2016

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Directions to “PHARMACA PHARMACY ” Practice Location

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