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Organization
USC I.D.S. PHARMACY
Active
Organization
USC I.D.S. PHARMACY
Active
Other names
USC I.D.S. Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT EVANS (C.O.O)
(323) 442-8677
Entity
Organization
Contact information
Practice address
1441 EASTLAKE AVE STE 2407, LOS ANGELES, CA 90089-0112
(323) 865-3538
(323) 865-0857
Mailing address
1441 EASTLAKE AVE, SUITE 2407, LOS ANGELES, CA 90089-0112
(323) 865-3538
(323) 865-0857
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY 50231
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5639058
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/01/2010
Last updated
10/01/2010
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