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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