Provider Demographics
NPI:1902350150
Name:EAST LA PHARMACY CORP
Entity Type:Organization
Organization Name:EAST LA PHARMACY CORP
Other - Org Name:EAST L.A. PHARMACY, CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFF. MNGR/ SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-685-5039
Mailing Address - Street 1:4968 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-3130
Mailing Address - Country:US
Mailing Address - Phone:323-685-5039
Mailing Address - Fax:323-685-2840
Practice Address - Street 1:4968 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-3130
Practice Address - Country:US
Practice Address - Phone:323-685-5039
Practice Address - Fax:323-685-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY54275333600000X, 333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162414OtherPK