MEDICARE: BEVERLY PROFESSIONAL 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY33172	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2066032	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598877581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY PROFESSIONAL PHARMACY

Provider Business Mailing Address
First Line	:	433 N 4TH ST
Second Line	:	SUITE 100
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4399
Country	:	US
Telephone Number	:	323-728-0248
Fax Number	:	323-728-9099

Provider Business Practice Location Address
First Line	:	433 N 4TH ST STE 100
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4313
Country	:	US
Telephone Number	:	323-728-0248
Fax Number	:	323-728-9099

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	MAHESH PATEL
Credential	:
Telephone Number	:	323-728-0248

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/09/2018

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Directions to “BEVERLY PROFESSIONAL PHARMACY ” Practice Location

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