MEDICARE: INTRA DRUGS ARTESIA

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 30812	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

General Provider Information

NPI Number	:	1457351140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTRA DRUGS ARTESIA

Provider Business Mailing Address
First Line	:	403 S LONG BEACH BLVD
Second Line	:	SUITE C
City	:	COMPTON
State	:	CA
Zip	:	90221-3449
Country	:	US
Telephone Number	:	310-639-1653
Fax Number	:	310-635-7374

Provider Business Practice Location Address
First Line	:	403 S LONG BEACH BLVD
Second Line	:	SUITE C
City	:	COMPTON
State	:	CA
Zip	:	90221-3449
Country	:	US
Telephone Number	:	310-639-1653
Fax Number	:	310-635-7374

Authorized Official
Title or Position	:	PHARMACY COORDINATOR
Name	:	MS. BIANCA BANKS
Credential	:
Telephone Number	:	310-639-1653

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	10/13/2010

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Directions to “INTRA DRUGS ARTESIA ” Practice Location

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