Provider Demographics
NPI:1619924297
Name:MEIJI PHARMACY INC
Entity Type:Organization
Organization Name:MEIJI PHARMACY INC
Other - Org Name:MEIJI PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCST
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMASHITA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:310-538-2885
Mailing Address - Street 1:1630 W REDONDO BEACH BLVD
Mailing Address - Street 2:STE 14
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3200
Mailing Address - Country:US
Mailing Address - Phone:310-538-2885
Mailing Address - Fax:310-538-0609
Practice Address - Street 1:1630 W REDONDO BEACH BLVD
Practice Address - Street 2:STE 14
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3200
Practice Address - Country:US
Practice Address - Phone:310-538-2885
Practice Address - Fax:310-538-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY452933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1998599OtherPK
CAPHA45293Medicaid
1998599OtherPK