MEDICARE: BIG 1 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	3336H0001X	Home Infusion Therapy Pharmacy
2	3336C0004X	Compounding Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336C0003X	Community/Retail Pharmacy	PHY43845	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1991792	OTHER		PK

General Provider Information

NPI Number	:	1992798698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG 1 INC

Provider Business Mailing Address
First Line	:	415 W VALLEY BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3728
Country	:	US
Telephone Number	:	626-281-2186
Fax Number	:	626-281-3583

Provider Business Practice Location Address
First Line	:	415 W VALLEY BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3728
Country	:	US
Telephone Number	:	626-281-2186
Fax Number	:	626-281-3583

Authorized Official
Title or Position	:	OFFICER
Name	:	STEVEN CHIN
Credential	:
Telephone Number	:	626-281-2186

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	12/22/2016

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Directions to “BIG 1 INC ” Practice Location

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