Provider Demographics
NPI:1518023720
Name:SERVRITE DRUG
Entity Type:Organization
Organization Name:SERVRITE DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-948-1905
Mailing Address - Street 1:9420 SLAUSON AVE
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4748
Mailing Address - Country:US
Mailing Address - Phone:562-948-1905
Mailing Address - Fax:562-948-3017
Practice Address - Street 1:9420 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4748
Practice Address - Country:US
Practice Address - Phone:562-948-1905
Practice Address - Fax:562-948-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY340093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY34009Medicaid
CAPHA340090OtherMEDICAL
CA0514136Medicare UPIN
CAPHY34009Medicaid