Athena Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · Baldwin Park, CA
NPI 1609938331 · NPPES record last updated Aug 22, 2023
Key facts
- NPI
- 1609938331
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- ATHENA PHARMACY INC
- Practice address
- 14332 Ramona Blvd.
Baldwin Park, CA 91706-3241 - Phone
- (626) 337-1510
- Fax
- (626) 337-1540
- NPI assigned
- Dec 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Olivia T Martinez
- Title
- Ceo
- Phone
- (626) 337-1510
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2295862 | 986 Pharmacy #8015 | Certificate of waiver | Dec 17, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| 986 Pharmacy #8015 |
Epoetin|Immunosuppressive Drugs|Nebulizer Drugs | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231117001287 | CA | DME Supplier - Pharmacy | 4688021363 | Practice locations: Baldwin Park, CA |
| O20260529001085 | CA | Part B Supplier - Mass Immunization (Roster Biller Only) | 4688021363 | Practice locations: Baldwin Park, CA |
National Provider Directory
Locations
1227 E Valley Blvd
Alhambra, CA 91801
Phone (626) 537-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
14332 Ramona Blvd.
Baldwin Park, CA 91706-3241
Mailing address
14332 Ramona Blvd.
Baldwin Park, CA 91706-3241
Phone (626) 337-1510
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 59003 | Other | CA | CA BOP |
Other names
- 986 Pharmacy #8015
Other providers in Baldwin Park, CA
- Arzu Dental Corporation
- Biniam Asmerom
- Armin Ataee
- Milani Lita Atanante
- Samia Gerets Ateia
- Linda M. Atkinson
- Rao Lakshmana Atluri
- Syama P Atluri
- Kim Auduong
- John H. Austin
All providers in Baldwin Park, 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 Aug 22, 2023. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.