MEDICARE: FISHERS DRUG STORE

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	PHY43708	CA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0548745	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578574158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FISHERS DRUG STORE

Provider Business Mailing Address
First Line	:	9601 LAS TUNAS DR
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 LAS TUNAS DR
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2109
Country	:	US
Telephone Number	:	626-286-3133
Fax Number	:	626-287-1700

Authorized Official
Title or Position	:	PHARMD
Name	:	SAMUEL PANG
Credential	:	PHARMD
Telephone Number	:	626-286-3133

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	09/11/2025

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Directions to “FISHERS DRUG STORE ” Practice Location

Language	Start Address	Practice Location

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