Provider Demographics
NPI:1194865006
Name:THREE TWENTY ONE PHARMACY
Entity Type:Organization
Organization Name:THREE TWENTY ONE PHARMACY
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYATA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:213-680-3822
Mailing Address - Street 1:310 E 2ND ST
Mailing Address - Street 2:THREE TWENTY ONE PHARMACY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4221
Mailing Address - Country:US
Mailing Address - Phone:213-680-3822
Mailing Address - Fax:213-680-2028
Practice Address - Street 1:310 E 2ND ST
Practice Address - Street 2:NONE
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4221
Practice Address - Country:US
Practice Address - Phone:213-680-3822
Practice Address - Fax:213-680-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY22971251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9106738Medicaid
CA9106738Medicaid