Provider Demographics
NPI:1770193641
Name:986 SPECIALTY PHARMACY PASADENA INC
Entity Type:Organization
Organization Name:986 SPECIALTY PHARMACY PASADENA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-798-6789
Mailing Address - Street 1:1719 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1611
Mailing Address - Country:US
Mailing Address - Phone:626-798-6789
Mailing Address - Fax:626-798-8376
Practice Address - Street 1:1719 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1611
Practice Address - Country:US
Practice Address - Phone:626-798-6789
Practice Address - Fax:626-798-8376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy