# PRIME PHARMACY SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PRIME PHARMACY SERVICES INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871767749
- **Authorized official:** RUSSELL SMITH (CFO)
- **Authorized official phone:** (805) 529-1195

## Contact information

- **Practice address:** 4211 AVALON BLVD, STE 2, LOS ANGELES, CA 90011-5622
- **Practice address phone:** (323) 432-5183
- **Practice address fax:** (323) 232-9414
- **Mailing address:** 3010 WILSHIRE BLVD, STE 222, LOS ANGELES, CA 90010-1146

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | PHY48954 | CA | Yes |

## Other

- **Enumeration date:** 04/22/2008
- **Last updated:** 08/11/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5630086 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |