MEDICARE: BIG A DRUG STORES INC

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	PHY43392	CA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0545220	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619066263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG A DRUG STORES INC

Provider Business Mailing Address
First Line	:	PO BOX 31001-0803
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91110-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2159 PACIFIC COAST HWY
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-2502
Country	:	US
Telephone Number	:	310-325-0150
Fax Number	:	310-325-6703

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDWARD DALLAL
Credential	:	RPH
Telephone Number	:	562-633-9578

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	09/11/2025

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Directions to “BIG A DRUG STORES INC ” Practice Location

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