Provider Demographics
NPI:1619019593
Name:ASHLEY & J PHARMACY CORP
Entity Type:Organization
Organization Name:ASHLEY & J PHARMACY CORP
Other - Org Name:ROSS MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:SEUNG
Authorized Official - Middle Name:YOL
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:323-731-8304
Mailing Address - Street 1:1818 S WESTERN AVE
Mailing Address - Street 2:100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5807
Mailing Address - Country:US
Mailing Address - Phone:323-731-8304
Mailing Address - Fax:323-731-0158
Practice Address - Street 1:1818 S WESTERN AVE
Practice Address - Street 2:100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5807
Practice Address - Country:US
Practice Address - Phone:323-731-8304
Practice Address - Fax:323-731-0158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 40147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA392670Medicaid
CA1115840001Medicare ID - Type Unspecified