Provider Demographics
NPI:1467431791
Name:SOUTH WESTERN PHARMACY
Entity Type:Organization
Organization Name:SOUTH WESTERN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUMBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-752-1692
Mailing Address - Street 1:7301 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-2254
Mailing Address - Country:US
Mailing Address - Phone:323-752-1692
Mailing Address - Fax:323-752-0710
Practice Address - Street 1:7301 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-2254
Practice Address - Country:US
Practice Address - Phone:323-752-1692
Practice Address - Fax:323-752-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48238183500000X
CAPHY 32368333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No333600000XSuppliersPharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY32368OtherMEDICAL ID NUMBER
CAPHY32368OtherMEDICAL ID NUMBER