Provider Demographics
NPI:1952831349
Name:CONCIERGE PHARMACY LLC
Entity Type:Organization
Organization Name:CONCIERGE PHARMACY LLC
Other - Org Name:CONCIERGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:630-242-8969
Mailing Address - Street 1:23215 HAWTHORNE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3772
Mailing Address - Country:US
Mailing Address - Phone:310-299-4999
Mailing Address - Fax:310-299-5999
Practice Address - Street 1:23215 HAWTHORNE BLVD STE B
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3772
Practice Address - Country:US
Practice Address - Phone:310-299-4999
Practice Address - Fax:310-299-5999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMC LYONS HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-18
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952831349Medicaid
CA57573OtherCALIFORNIA BOARD OF PHARMACY