Provider Demographics
NPI:1437237435
Name:WHITTIER PLAZA PHARMACY, INC.
Entity Type:Organization
Organization Name:WHITTIER PLAZA PHARMACY, INC.
Other - Org Name:THE PRESCRIPTION SHOP- WHITTIER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NAGI
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-464-6655
Mailing Address - Street 1:14350 WHITTIER BLVD
Mailing Address - Street 2:SUITE, 103
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2138
Mailing Address - Country:US
Mailing Address - Phone:562-464-6655
Mailing Address - Fax:562-464-6657
Practice Address - Street 1:14350 WHITTIER BLVD
Practice Address - Street 2:SUITE, 103
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2138
Practice Address - Country:US
Practice Address - Phone:562-464-6655
Practice Address - Fax:562-464-6657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY448773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA44877Medicaid
1321480001Medicare PIN