Organization
MAURO CAL MED PHARMACY INC
Active
Organization
MAURO CAL MED PHARMACY INC
Active
Other names
MAURO CAL MED PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KI SON (PHARMACIST)
(213) 746-4677
Entity
Organization
Contact information
Practice address
1414 S GRAND AVE, STE 101, LOS ANGELES, CA 90015-3067
(213) 746-4677
(213) 746-8796
Mailing address
1414 S GRAND AVE, STE 101, LOS ANGELES, CA 90015-3067
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY39967
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0540458
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA399670
—
CA
Enumeration date
12/28/2006
Last updated
04/29/2009
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