Provider Demographics
NPI:1851991012
Name:MCGADY, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MCGADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17025 WILKIE AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-2823
Mailing Address - Country:US
Mailing Address - Phone:310-489-2663
Mailing Address - Fax:
Practice Address - Street 1:450 E SPRING ST STE 11
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1625
Practice Address - Country:US
Practice Address - Phone:562-933-7702
Practice Address - Fax:562-933-7705
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA651841835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND-889443OtherBOARD CERTIFIED PHARMACOTHERAPY SPECIALIST (BCPS)