Wayne Siu Et Al PTR

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY38258 Issued in CA

Legal business name

WAYNE SIU ET AL PTR

Practice address

1505 Wilson Ter
Ste 100
Glendale, CA 91206-4071

Phone

(818) 409-8392

Fax

(818) 956-7631

NPI assigned

Aug 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wayne Siu

Title

Owner

Phone

(818) 409-8392

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• MEDICAL TERRACE PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490745600000",
    "number": "1043322035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 WILSON TER",
            "address_2": "STE 100",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064071",
            "telephone_number": "818-409-8392",
            "fax_number": "818-956-7631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 WILSON TER",
            "address_2": "STE 100",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064071",
            "telephone_number": "818-409-8392",
            "fax_number": "818-956-7631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE SIU ET AL PTR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2017-03-29",
        "status": "A",
        "authorized_official_last_name": "SIU",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-409-8392"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY38258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2066992",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA382580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL TERRACE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Washington, NP
• Stephanie Watanabe, D.P.T.
• Albe M Watkins Jr., MD
• Leland E Watkins, MD
• Carrie Watson
• We Can Therapy LLC
• Lisa Weber, LAC
• Sanford Roy Weimer, MD
• Melanie Weinraub
• Richard A Weise, MD

• Community/Retail Pharmacy in Glendale, CA
• Providers in Glendale, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.