Organization
PROVIDENCE PHARMACEUTICALS INC
Active
Other names
Econo Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA CHOI (PRESIDENT)
(310) 353-2699
Entity
Organization
Contact information
Practice address
15435 S WESTERN AVE, STE 100 C, GARDENA, CA 90249-4323
(310) 353-2695
(310) 353-2696
Mailing address
15435 S WESTERN AVE, STE 100 C, GARDENA, CA 90249-4323
(310) 353-2695
(310) 353-2696
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY51680
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143869
PK
—
Enumeration date
08/10/2006
Last updated
02/21/2017
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