MEDICARE: 986 SPECIALTY PHARMACY PASADENA 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1831299874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	986 SPECIALTY PHARMACY PASADENA INC

Provider Business Mailing Address
First Line	:	1719 E. WALNUT ST.
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1611
Country	:	US
Telephone Number	:	626-798-6789
Fax Number	:	626-798-8376

Provider Business Practice Location Address
First Line	:	1719 E. WALNUT ST.
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1611
Country	:	US
Telephone Number	:	626-798-6789
Fax Number	:	626-798-8376

Authorized Official
Title or Position	:	VP
Name	:	MR. SIMON CHAN
Credential	:
Telephone Number	:	626-798-6789

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	09/29/2021

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