Provider Demographics
NPI:1588616791
Name:PHARMEDCARE LLC
Entity Type:Organization
Organization Name:PHARMEDCARE LLC
Other - Org Name:COSLO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:KIT
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-289-0018
Mailing Address - Street 1:150 S RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3166
Mailing Address - Country:US
Mailing Address - Phone:626-289-0018
Mailing Address - Fax:626-289-0268
Practice Address - Street 1:150 S RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3166
Practice Address - Country:US
Practice Address - Phone:626-289-0018
Practice Address - Fax:626-289-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2018-12-03
Deactivation Date:2018-03-21
Deactivation Code:
Reactivation Date:2018-03-27
Provider Licenses
StateLicense IDTaxonomies
333600000X, 332B00000X, 333600000X
CAPHY546083336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA476150Medicaid
2115115OtherPK
5813070001Medicare NSC