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Organization
PRIME PHARMACY SERVICES INC
Active
Organization
PRIME PHARMACY SERVICES INC
Active
Other names
PRIME PHARMACY SERVICES INC
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL SMITH (CFO)
(805) 529-1195
Entity
Organization
Contact information
Practice address
4211 AVALON BLVD, STE 2, LOS ANGELES, CA 90011-5622
(323) 432-5183
(323) 232-9414
Mailing address
3010 WILSHIRE BLVD, STE 222, LOS ANGELES, CA 90010-1146
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
PHY48954
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5630086
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/22/2008
Last updated
08/11/2008
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