Provider Demographics
NPI:1508955154
Name:BIG A DRUGSTORE
Entity Type:Organization
Organization Name:BIG A DRUGSTORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:562-633-9578
Mailing Address - Street 1:PO BOX 31001
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8111 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3204
Practice Address - Country:US
Practice Address - Phone:562-430-0556
Practice Address - Fax:562-430-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY43390333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0599160OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA433900Medicaid
0599160OtherOTHER ID NUMBER-COMMERCIAL NUMBER