Provider Demographics
NPI:1467650713
Name:BELLA VIDA PHARMACY INC
Entity Type:Organization
Organization Name:BELLA VIDA PHARMACY INC
Other - Org Name:BELLA VIDA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-320-3333
Mailing Address - Street 1:1037 W CARSON ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2005
Mailing Address - Country:US
Mailing Address - Phone:310-320-3333
Mailing Address - Fax:310-320-3334
Practice Address - Street 1:1037 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2005
Practice Address - Country:US
Practice Address - Phone:310-320-3333
Practice Address - Fax:310-320-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 50550333600000X, 3336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56-27510OtherNCPDP PROVIDER NUMBER
CAPHY50550OtherRETAIL PHARMACY PERMIT
CAPHY50550OtherRETAIL PHARMACY PERMIT