Provider Demographics
NPI:1245426964
Name:CNS PHARMACY INC
Entity type:Organization
Organization Name:CNS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:HO
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-385-9926
Mailing Address - Street 1:2426 W 8TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3979
Mailing Address - Country:US
Mailing Address - Phone:213-385-9926
Mailing Address - Fax:213-385-9927
Practice Address - Street 1:2426 W 8TH ST
Practice Address - Street 2:STE 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3979
Practice Address - Country:US
Practice Address - Phone:213-385-9926
Practice Address - Fax:213-385-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154773OtherPK
CAPHA454700Medicaid
5578070001Medicare NSC