Provider Demographics
NPI:1730498684
Name:MISSION PHARMACY AND MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:MISSION PHARMACY AND MEDICAL SUPPLIES INC.
Other - Org Name:MISSION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONABEDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:626-797-6099
Mailing Address - Street 1:1131 N PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2358
Mailing Address - Country:US
Mailing Address - Phone:818-551-1131
Mailing Address - Fax:818-551-1140
Practice Address - Street 1:1131 N PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2358
Practice Address - Country:US
Practice Address - Phone:818-551-1131
Practice Address - Fax:818-551-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CA504173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies