Prevost Healthcare Enterprises Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY37108 Issued in CA

Legal business name

PREVOST HEALTHCARE ENTERPRISES INC

Practice address

9909 Compton Ave
Los Angeles, CA 90002-2850

Phone

(323) 564-3218

Fax

(323) 564-4064

NPI assigned

Oct 6, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Walter Jerome Prevost Sr., PHARM. D.NPI 1629035621

Title

Pharmacist Ceo

Phone

(323) 564-3218

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• WATTS PROFESSIONAL PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Locations

Practitioners 1

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

• Walter Jerome Prevost Sr., PHARM.D.

  • Pharmacist
  • Los Angeles, CA
  • NPI 1629035621
  NPD Authorized official

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299715200000",
    "number": "1619965357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16709 AMBERWOOD WAY",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907031190",
            "telephone_number": "323-564-3218",
            "fax_number": "323-564-4064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9909 COMPTON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900022850",
            "telephone_number": "323-564-3218",
            "fax_number": "323-564-4064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVOST HEALTHCARE ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2011-03-10",
        "status": "A",
        "authorized_official_last_name": "PREVOST",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "PHARMACIST CEO",
        "authorized_official_telephone_number": "323-564-3218",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "PHARM. D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "PHA371080",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY37108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA371080",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WATTS PROFESSIONAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Craig Pretlow
• Joshua Emanuel Pretsky, M.D.
• Nicholas Preuitt, PHARM.D.
• Prevent the Pain Therapy, Inc.
• Preventative Cardiology PC
• Walter Jerome Prevost Sr., PHARM.D.
• Zoya Preys, M.D.
• Susana Preza, NP
• Hresanthe Prezas-Peretz
• Anjuli Price

• Community/Retail Pharmacy in Los Angeles, CA
• Providers in Los Angeles, 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 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.