Organization
PREVOST HEALTHCARE ENTERPRISES INC
Active
Other names
WATTS PROFESSIONAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER JEROME PREVOST SR. PHARM. D. (PHARMACIST CEO)
(323) 564-3218
Entity
Organization
Contact information
Practice address
9909 COMPTON AVE, LOS ANGELES, CA 90002-2850
(323) 564-3218
(323) 564-4064
Mailing address
16709 AMBERWOOD WAY, CERRITOS, CA 90703-1190
(323) 564-3218
(323) 564-4064
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHA371080
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY37108
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA371080
—
CA
Enumeration date
10/06/2005
Last updated
03/10/2011
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