Provider Demographics
NPI:1093875577
Name:LOS ANGELES DRUGS
Entity Type:Organization
Organization Name:LOS ANGELES DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:IM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-387-3030
Mailing Address - Street 1:3030 WEST OLYMPIC BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006
Mailing Address - Country:US
Mailing Address - Phone:213-387-3030
Mailing Address - Fax:213-739-2020
Practice Address - Street 1:3030 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-6501
Practice Address - Country:US
Practice Address - Phone:213-387-3030
Practice Address - Fax:213-739-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY438293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA438290Medicaid
CA09903750001Medicare ID - Type UnspecifiedMEDICARE NUMBER