Provider Demographics
NPI:1740201797
Name:CALIFORNIA PHARMACY ASSOCIATES INC
Entity Type:Organization
Organization Name:CALIFORNIA PHARMACY ASSOCIATES INC
Other - Org Name:COMMUNITY MED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAI
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-859-2573
Mailing Address - Street 1:315 N 3RD AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1905
Mailing Address - Country:US
Mailing Address - Phone:626-859-2573
Mailing Address - Fax:626-859-2575
Practice Address - Street 1:315 N 3RD AVE
Practice Address - Street 2:STE 101
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1905
Practice Address - Country:US
Practice Address - Phone:626-859-2573
Practice Address - Fax:626-859-2575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY458483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1999060OtherPK
CAPHA374130Medicaid
1999060OtherPK