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Organization
WEST COVINA MEDICAL CENTER INC
Active
Organization
WEST COVINA MEDICAL CENTER INC
Active
Other names
West Covina Medical Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL KOO (PIC)
(626) 502-1991
Entity
Organization
Contact information
Practice address
725 S ORANGE AVE, WEST COVINA, CA 91790-2614
(626) 502-1991
(626) 502-1971
Mailing address
725 S ORANGE AVE, WEST COVINA, CA 91790-2614
(626) 502-1991
(626) 502-1971
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0004X
Compounding Pharmacy
—
NULL
3336I0012X
Institutional Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
53643
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160697
PK
—
Enumeration date
07/14/2016
Last updated
04/21/2017
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