MEDICARE: APPLIED PHARMACY SERVIVES, LLC

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	183500000X	Pharmacist	PHY48340	CA

General Provider Information

NPI Number	:	1760517593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLIED PHARMACY SERVIVES, LLC

Provider Business Mailing Address
First Line	:	2620 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3746
Country	:	US
Telephone Number	:	626-795-3555
Fax Number	:	626-795-3553

Provider Business Practice Location Address
First Line	:	2620 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3746
Country	:	US
Telephone Number	:	626-795-3555
Fax Number	:	626-795-3553

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	DR. TIMOTHY ANTHONY LOPEZ
Credential	:	PHARM.D.
Telephone Number	:	626-795-3555

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	10/30/2007

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