MEDICARE: AMERICANA APOTHECARY 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY47349	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0535368	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871605865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICANA APOTHECARY INC

Provider Business Mailing Address
First Line	:	4057 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2536
Country	:	US
Telephone Number	:	323-264-7311
Fax Number	:	323-266-8202

Provider Business Practice Location Address
First Line	:	4057 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2536
Country	:	US
Telephone Number	:	323-264-7311
Fax Number	:	323-266-8202

Authorized Official
Title or Position	:	OWNER
Name	:	PING CHAN
Credential	:
Telephone Number	:	323-264-7311

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/07/2009

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Directions to “AMERICANA APOTHECARY INC ” Practice Location

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