Organization
PHARMACA INTEGRATIVE PHARMACY INC
Active
Other names
Medly Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ALISON FARRELL (SVP PHARMACY SERVICES)
(717) 254-9011
Entity
Organization
Contact information
Practice address
12025 SAN VICENTE BLVD, LOS ANGELES, CA 90049
(310) 476-1237
(310) 476-0152
Mailing address
7088 WINCHESTER CIR STE 100, BOULDER, CO 80301-3760
(303) 442-2304
(303) 867-4181
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
49065
CA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0500024
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/13/2005
Last updated
07/22/2022
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