Provider Demographics
NPI:1710034657
Name:TWIN PHARMACY INC.
Entity Type:Organization
Organization Name:TWIN PHARMACY INC.
Other - Org Name:DABNEY'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON RUANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-757-2263
Mailing Address - Street 1:11115 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-1925
Mailing Address - Country:US
Mailing Address - Phone:323-757-2263
Mailing Address - Fax:323-757-7792
Practice Address - Street 1:11115 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-1925
Practice Address - Country:US
Practice Address - Phone:323-757-2263
Practice Address - Fax:323-757-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
CA3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0506610OtherNCPDP
CAPHA467450OtherMEDI-CAL
CAPHY46745OtherCALIFORNIA PHARM LICENSE
CA0506610OtherNCPDP