Active NPI
Broadway Medical Pharmacy
- Pharmacist
- Anaheim, CA
National Provider Identifier
1154461085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PHY40768
- Legal business name
- BROADWAY MEDICAL PHARMACY
- Practice address
- 1673 W Broadway Ste 1
Anaheim, CA 92802-1109 - Phone
- (714) 772-3630
- Fax
- (714) 772-3631
- NPI assigned
- Feb 8, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Van Phi Le, RPH41632
- Title
- Direct Owner
- Phone
- (714) 772-3630
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PHY40768 | CA | Primary |
Addresses
Primary practice location
1673 W Broadway Ste 1
Anaheim, CA 92802-1109
Mailing address
1673 W. Broadway Suit #1
Anaheim, CA 92802
Phone (714) 772-3630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHA407680 | Medicaid | CA |
National Provider Directory
National Provider Directory- Tax ID family
- Broadway Medical Pharmacy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Anaheim, CA
- NPI 1801072749
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Anaheim, CA
- NPI 1285707604
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1154461085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1673 W. BROADWAY SUIT #1",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "92802",
"telephone_number": "714-772-3630",
"fax_number": "714-772-3631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1673 W BROADWAY STE 1",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928021109",
"telephone_number": "714-772-3630",
"fax_number": "714-772-3631"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROADWAY MEDICAL PHARMACY",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-08",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "LE",
"authorized_official_first_name": "VAN",
"authorized_official_middle_name": "PHI",
"authorized_official_title_or_position": "DIRECT OWNER",
"authorized_official_telephone_number": "714-772-3630",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "RPH41632"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pharmacist",
"state": "CA",
"license": "PHY40768",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PHA407680",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.