MEDICARE: CALIFORNIA MEDICAL 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0564535	OTHER	CA	NABP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770583387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA MEDICAL PHARMACY INC

Provider Business Mailing Address
First Line	:	2201 W TEMPLE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4917
Country	:	US
Telephone Number	:	213-413-2343
Fax Number	:	213-413-1354

Provider Business Practice Location Address
First Line	:	2201 W TEMPLE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4917
Country	:	US
Telephone Number	:	213-413-2343
Fax Number	:	213-413-1354

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	03/23/2016

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