Provider Demographics
NPI:1821164146
Name:WHITE MEMORIAL MEDICAL PLAZA PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:WHITE MEMORIAL MEDICAL PLAZA PHARMACY SERVICES INC
Other - Org Name:WHITE MEMORIAL MEDICAL PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PARESHKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-221-6000
Mailing Address - Street 1:1701 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-221-6000
Mailing Address - Fax:323-221-0999
Practice Address - Street 1:1701 E CESAR E CHAVEZ AVE
Practice Address - Street 2:STE 109
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-221-6000
Practice Address - Fax:323-221-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0505187OtherNCPDP NUMBER
CA0505187OtherNCPDP NUMBER
CAPHA399440Medicaid
CA0995340001Medicare ID - Type Unspecified