Provider Demographics
NPI:1629095336
Name:A & A UNIVERSAL PHARMACY INC
Entity Type:Organization
Organization Name:A & A UNIVERSAL PHARMACY INC
Other - Org Name:A AND A UNIVERSAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGNACKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:310-897-5766
Mailing Address - Street 1:866 N VERMONT AVE # 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-3587
Mailing Address - Country:US
Mailing Address - Phone:323-660-6666
Mailing Address - Fax:323-660-6665
Practice Address - Street 1:866 N VERMONT AVE # 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-3587
Practice Address - Country:US
Practice Address - Phone:323-660-6666
Practice Address - Fax:323-660-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY475223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5622938OtherNCPDP PROVIDER IDENTIFICATION NUMBER