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Organization
WAYNE SIU ET AL PTR
Active
Organization
WAYNE SIU ET AL PTR
Active
Other names
MEDICAL TERRACE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE SIU (OWNER)
(818) 409-8392
Entity
Organization
Contact information
Practice address
1505 WILSON TER, STE 100, GLENDALE, CA 91206-4071
(818) 409-8392
(818) 956-7631
Mailing address
1505 WILSON TER, STE 100, GLENDALE, CA 91206-4071
(818) 409-8392
(818) 956-7631
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY38258
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2066992
PK
—
05
—
PHA382580
—
CA
Enumeration date
08/31/2006
Last updated
03/29/2017
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