PNK Pharmacy, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

53822 Issued in CA

Legal business name

PNK PHARMACY, INC.

Doing business as

TLC MEDICAL ARTS PHARMACY

Practice address

1500 W West Covina Pkwy
Ste 100
West Covina, CA 91790-2708

Phone

(626) 338-7233

Fax

(626) 338-7255

NPI assigned

Dec 26, 2006

Organization subpart

No

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

Authorized official

Name

Kamlesh Trikambhai ManiaNPI 1023483385

Title

Owner

Phone

(626) 338-7233

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• TLC MEDICAL ARTS PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kamlesh T Mania

  • Pharmacist
  • West Covina, CA
  • NPI 1023483385
  NPD Authorized official

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485907200000",
    "number": "1114082542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 W WEST COVINA PKWY",
            "address_2": "STE 100",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917902708",
            "telephone_number": "626-338-7233",
            "fax_number": "626-338-7255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 W WEST COVINA PKWY",
            "address_2": "STE 100",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917902708",
            "telephone_number": "626-338-7233",
            "fax_number": "626-338-7255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PNK PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2017-02-01",
        "status": "A",
        "authorized_official_last_name": "MANIA",
        "authorized_official_first_name": "KAMLESH",
        "authorized_official_middle_name": "TRIKAMBHAI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-338-7233"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "53822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5624730",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TLC MEDICAL ARTS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Angelina Ponce

• Community/Retail Pharmacy in West Covina, CA
• Providers in West Covina, 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 Feb 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.