Provider Demographics
NPI:1083826135
Name:PAI AND CHAN PHARMACY CORP
Entity Type:Organization
Organization Name:PAI AND CHAN PHARMACY CORP
Other - Org Name:MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:PAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:310-671-7636
Mailing Address - Street 1:501 E. HARDY ST.
Mailing Address - Street 2:#130
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4055
Mailing Address - Country:US
Mailing Address - Phone:310-671-7636
Mailing Address - Fax:310-671-0971
Practice Address - Street 1:501 E. HARDY ST.
Practice Address - Street 2:#130
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4055
Practice Address - Country:US
Practice Address - Phone:310-671-7636
Practice Address - Fax:310-671-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY504133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0569927OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA437360Medicaid
0569927OtherOTHER ID NUMBER-COMMERCIAL NUMBER