BLM Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · La Mirada, CA
NPI 1497201768 · NPPES record last updated Dec 7, 2016
Key facts
- NPI
- 1497201768
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHY53361 (CA)
- Legal business name
- BLM PHARMACY INC
- Practice address
- 12675 La Mirada Blvd.
Suite 100
La Mirada, CA 90638 - Phone
- (562) 777-8175
- Fax
- (562) 777-7156
- NPI assigned
- Aug 28, 2016
- Organization subpart
- No
Authorized official
- Name
- Tobias Porter
- Title
- President
- Phone
- (562) 777-8175
Practitioners 1
-
Christopher Jared Wall, PHARM D
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161209000146 | CA | DME Supplier - Pharmacy | 9032499041 | Practice locations: La Mirada, CA |
National Provider Directory
Locations
12675 La Mirada Blvd
Ste 100
La Mirada, CA 90638
Phone (562) 777-8175
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PHY53361 | CA | Yes |
Addresses
Primary practice location
12675 La Mirada Blvd.
Suite 100
La Mirada, CA 90638
Mailing address
12675 La Mirada Blvd.
Suite 100
La Mirada, CA 90638
Phone (562) 777-8175
Other names
- Bright La Mirada Pharmacy
Other providers in La Mirada, CA
- Shalini Bhargava
- Nimisha M Bhatt
- Hanna Chang Bin
- Biola Counseling Center
- Berry Jane Bishop
- Lorna Borja
- Brittany Bourne
- Jessica Rose Bozarth
- Bright Medical Associates, Inc.
- Patti L. Bruha
All providers in La Mirada, CA · Community/Retail Pharmacy in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.