Organization
6122PHARMACY
Active
Organization
6122PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL KONG PHD (PRESIDENT)
(323) 725-1250
Entity
Organization
Contact information
Practice address
6122 WHITTIER BLVD, LOS ANGELES, CA 90022-4504
(323) 725-1250
(323) 726-9091
Mailing address
6122 WHITTIER BLVD, LOS ANGELES, CA 90022-4504
(323) 725-1250
(323) 726-9091
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY30457
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA304570
—
CA
Enumeration date
04/06/2007
Last updated
08/22/2020
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