MEDICARE: PEDIATRIC CARE PHARMACY 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	BP3394397	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0565905	OTHER	CA	NABP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699755637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC CARE PHARMACY INC

Provider Business Mailing Address
First Line	:	4616 DE LONGPRE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6076
Country	:	US
Telephone Number	:	213-413-2343
Fax Number	:	323-913-5820

Provider Business Practice Location Address
First Line	:	4616 DE LONGPRE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6076
Country	:	US
Telephone Number	:	323-913-5801
Fax Number	:	323-913-5820

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS J LIAUTAUD
Credential	:	RPH
Telephone Number	:	213-413-2343

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1891982658 — WALGREEN CO.
Practice Location Address:

4616 DE LONGPRE AVE
LOS ANGELES, CA
90027-6076

Practice Phone: 323-644-2080
Practice Fax: 323-644-2083

1023387131 — DR. DERON PAUL JOHNSON
Practice Location Address:

4616 DE LONGPRE AVE
LOS ANGELES, CA
90027-6076

Practice Phone: 323-361-4182
Practice Fax: 323-644-2084

1871215418 — THAO NGUYEN PHARMD
Practice Location Address:

4616 DE LONGPRE AVE
LOS ANGELES, CA
90027-6076

Practice Phone: 323-644-2080
Practice Fax:

1356858633 — KELLY SUE CLARK OTR/L
Practice Location Address:

6076 BRISTOL PKWY STE 105
LOS ANGELES, CA
90230-6600

Practice Phone: 310-642-7700
Practice Fax: 310-642-7700

1538772447 — ALICE ELLIOTT SMITH LMFT
Practice Location Address:

3033 ST GEORGE ST
LOS ANGELES, CA
90027-2516

Practice Phone: 323-710-6076
Practice Fax:

1770558819 — DRUG WORLD OF COLD SPRING, LLC
Practice Location Address:

55 CHESTNUT STREET
COLD SPRING, NY
10516

Practice Phone: 845-265-6352
Practice Fax: 845-265-6076

Directions to “PEDIATRIC CARE PHARMACY INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.