Provider Demographics
NPI:1912014820
Name:CONSUMERS DISCOUNT DRUG STORES
Entity Type:Organization
Organization Name:CONSUMERS DISCOUNT DRUG STORES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:DECUIR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:323-461-3606
Mailing Address - Street 1:6542 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6217
Mailing Address - Country:US
Mailing Address - Phone:323-461-3606
Mailing Address - Fax:323-461-3600
Practice Address - Street 1:6542 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6217
Practice Address - Country:US
Practice Address - Phone:323-461-3606
Practice Address - Fax:323-461-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0506634OtherNABP #
CAPHF141910Medicaid
CAAC7033854OtherDEA #