Provider Demographics
NPI:1831302199
Name:DEL AMO PROFESSIONAL PHARMACY
Entity Type:Organization
Organization Name:DEL AMO PROFESSIONAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:V
Authorized Official - Last Name:ESCALLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-543-1331
Mailing Address - Street 1:21320 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5606
Mailing Address - Country:US
Mailing Address - Phone:310-543-1331
Mailing Address - Fax:310-543-0020
Practice Address - Street 1:21320 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5606
Practice Address - Country:US
Practice Address - Phone:310-543-1331
Practice Address - Fax:310-543-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY227033336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1175260001Medicare ID - Type UnspecifiedMEDICARE