Provider Demographics
NPI:1184621385
Name:FOBI COMPREHENSIVE PHARMACY, INC
Entity type:Organization
Organization Name:FOBI COMPREHENSIVE PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:FOBI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:562-630-5700
Mailing Address - Street 1:7922 ROSECRANS AVE STE P-2
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-6009
Mailing Address - Country:US
Mailing Address - Phone:562-630-5700
Mailing Address - Fax:562-630-5705
Practice Address - Street 1:7922 ROSECRANS AVE STE P-2
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-6009
Practice Address - Country:US
Practice Address - Phone:562-630-5700
Practice Address - Fax:562-630-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 470453336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
7578290001Medicare NSC