Provider Demographics
NPI:1861504789
Name:WEST COVINA PHARMACY INC
Entity Type:Organization
Organization Name:WEST COVINA PHARMACY INC
Other - Org Name:WEST COVINA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:CHEUK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-839-9882
Mailing Address - Street 1:1661 HANOVER RD
Mailing Address - Street 2:STE 104B
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1796
Mailing Address - Country:US
Mailing Address - Phone:626-839-9882
Mailing Address - Fax:626-839-9166
Practice Address - Street 1:1661 HANOVER RD
Practice Address - Street 2:STE 104B
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1796
Practice Address - Country:US
Practice Address - Phone:626-839-9882
Practice Address - Fax:626-839-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY461013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1997674OtherPK
CAPHA461010Medicaid
4639950001Medicare NSC
4639950001Medicare NSC