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NPI Code Detail

MEDICARE: MERCED MEDICAL PHARMACY

MEDICARE: MERCED MEDICAL 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
1333600000XPharmacyPHY 48915CA

General Provider Information

NPI Number : 1568647758
Entity Type Code : Organization
Provider Name (Legal Business Name) : MERCED MEDICAL PHARMACY
Provider Business Mailing Address
First Line : 1515 W MERCED AVE
Second Line :
City : WEST COVINA
State : CA
Zip : 91790-3403
Country : US
Telephone Number : 626-962-3685
Fax Number :
Provider Business Practice Location Address
First Line : 1515 W MERCED AVE
Second Line :
City : WEST COVINA
State : CA
Zip : 91790-3403
Country : US
Telephone Number : 626-962-3685
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. MINAH KIM
Credential : PHARM. D.
Telephone Number : 626-962-3685
Provider Enumeration Date : 01/07/2008
Last Update Date : 01/07/2008

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Directions to “MERCED MEDICAL PHARMACY ” Practice Location

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