Provider Demographics
NPI:1114151420
Name:PHARM WORKS RX, INC
Entity Type:Organization
Organization Name:PHARM WORKS RX, INC
Other - Org Name:BELLA VISTA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:323-264-6300
Mailing Address - Street 1:2099 S ATLANTIC BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6355
Mailing Address - Country:US
Mailing Address - Phone:323-264-6300
Mailing Address - Fax:323-264-6333
Practice Address - Street 1:2099 S ATLANTIC BLVD STE H
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6355
Practice Address - Country:US
Practice Address - Phone:323-264-6300
Practice Address - Fax:323-264-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 499083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6333070001Medicare NSC