Provider Demographics
NPI:1235284977
Name:LGJL INC
Entity Type:Organization
Organization Name:LGJL INC
Other - Org Name:PATTON'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM D
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEONI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-451-1414
Mailing Address - Street 1:734 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-451-1414
Mailing Address - Fax:310-458-5994
Practice Address - Street 1:734 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-451-1414
Practice Address - Fax:310-458-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH23118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0500733OtherNABP
CA18675651OtherRESAVE
CAA216940Medicaid
CA18675651OtherRESAVE