Provider Demographics
NPI:1245350230
Name:NEW CENTURY PHARMACY
Entity type:Organization
Organization Name:NEW CENTURY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MYOUNGJOON
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-989-2333
Mailing Address - Street 1:8227 WOODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-5426
Mailing Address - Country:US
Mailing Address - Phone:818-989-2333
Mailing Address - Fax:818-989-2675
Practice Address - Street 1:8227 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5426
Practice Address - Country:US
Practice Address - Phone:818-989-2333
Practice Address - Fax:818-989-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY45171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA451710Medicaid
CA0559798OtherNCPDP
CAPHY45171OtherRETAIL PHARMACY PERMIT