Provider Demographics
NPI:1215398755
Name:LONG BEACH MEMORIAL MEDICAL
Entity Type:Organization
Organization Name:LONG BEACH MEMORIAL MEDICAL
Other - Org Name:TODD CANCER PAVILION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-377-3218
Mailing Address - Street 1:450 E SPRING ST STE 11
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1625
Mailing Address - Country:US
Mailing Address - Phone:562-933-2273
Mailing Address - Fax:562-933-2907
Practice Address - Street 1:2810 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1558
Practice Address - Country:US
Practice Address - Phone:562-933-1844
Practice Address - Fax:562-933-1869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336I0012X
CA535823336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158354OtherPK