Provider Demographics
NPI:1376057612
Name:SJ PHARMACY INVESTMENT INC.
Entity Type:Organization
Organization Name:SJ PHARMACY INVESTMENT INC.
Other - Org Name:J PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:HYUN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:323-836-3686
Mailing Address - Street 1:356 S WESTERN AVE STE 104-105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3814
Mailing Address - Country:US
Mailing Address - Phone:213-908-6424
Mailing Address - Fax:213-908-6310
Practice Address - Street 1:356 S WESTERN AVE STE 104-105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3814
Practice Address - Country:US
Practice Address - Phone:213-908-6424
Practice Address - Fax:213-908-6310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-23
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0003X, 3336C0003X
CA558063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1376057612Medicaid