Provider Demographics
NPI:1578626222
Name:CTM PHARMACY CORP
Entity Type:Organization
Organization Name:CTM PHARMACY CORP
Other - Org Name:ALPHA MEDICAL PHARMACY1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAJIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-289-1990
Mailing Address - Street 1:703 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3232
Mailing Address - Country:US
Mailing Address - Phone:626-289-1990
Mailing Address - Fax:626-289-0344
Practice Address - Street 1:703 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3232
Practice Address - Country:US
Practice Address - Phone:626-289-1990
Practice Address - Fax:626-289-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578626222Medicaid
CA0591544Medicare UPIN