Provider Demographics
NPI:1124196803
Name:DR. JEFFREY A. BARRIS A PROFESSIONAL PHARMACY CORPORATION
Entity Type:Organization
Organization Name:DR. JEFFREY A. BARRIS A PROFESSIONAL PHARMACY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-530-0831
Mailing Address - Street 1:23560 MADISON ST STE 112
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4709
Mailing Address - Country:US
Mailing Address - Phone:310-530-0831
Mailing Address - Fax:310-530-8218
Practice Address - Street 1:23560 MADISON ST STE 112
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4709
Practice Address - Country:US
Practice Address - Phone:310-530-0831
Practice Address - Fax:310-530-8218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 26609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1111830001Medicare NSC