Provider Demographics
NPI:1114054954
Name:HEALTHCARE MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:HEALTHCARE MEDICAL SUPPLIES INC
Other - Org Name:EZCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO /DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NILESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTADIYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-587-0400
Mailing Address - Street 1:1535 W MERCED AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3404
Mailing Address - Country:US
Mailing Address - Phone:626-587-0400
Mailing Address - Fax:626-587-0403
Practice Address - Street 1:1535 W MERCED AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3404
Practice Address - Country:US
Practice Address - Phone:626-587-0400
Practice Address - Fax:626-587-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556263336C0003X
CAPHY201973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114054954Medicaid
0524442OtherNCPDP PROVIDER IDENTIFICATION NUMBER