Provider Demographics
NPI:1689733784
Name:BRIAN B MIN
Entity Type:Organization
Organization Name:BRIAN B MIN
Other - Org Name:VALLEY WEST MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-289-4343
Mailing Address - Street 1:1935 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-2346
Mailing Address - Country:US
Mailing Address - Phone:626-289-4343
Mailing Address - Fax:626-289-9336
Practice Address - Street 1:1935 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-2346
Practice Address - Country:US
Practice Address - Phone:626-289-4343
Practice Address - Fax:626-289-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH35960183500000X
CA48957332B00000X
CAPHY48957333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA413380Medicaid
0525432OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA413380Medicaid