Provider Demographics
NPI:1275107757
Name:GARFIELD PRESCRIPTION PHARMACY
Entity Type:Organization
Organization Name:GARFIELD PRESCRIPTION PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HYO SOO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-295-5585
Mailing Address - Street 1:3756 SANTA ROSALIA DR.
Mailing Address - Street 2:GARFIELD PRESCRIPTION PHARMACY (LOBBY)
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3606
Mailing Address - Country:US
Mailing Address - Phone:323-295-5585
Mailing Address - Fax:323-293-7789
Practice Address - Street 1:3756 SANTA ROSALIA DR LBBY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:323-295-5585
Practice Address - Fax:323-293-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA447060Medicaid