Organization
FAIRVEOLA BANKS
Active
Other names
Intra Rx Drugs Lynwood
Organization subpart
No
Provider details
NPI number
Authorized official
BIANCA BANKS (PHARMACY COORDINATOR)
(310) 637-2006
Entity
Organization
Contact information
Practice address
3628 E IMPERIAL HWY, STE 102, LYNWOOD, CA 90262-2643
(310) 637-2006
(310) 637-2522
Mailing address
3628 E IMPERIAL HWY, STE 102, LYNWOOD, CA 90262-2643
(310) 637-2006
(310) 637-2522
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY48607
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2127503
PK
—
Enumeration date
09/29/2005
Last updated
02/21/2017
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