Providence Pharmaceuticals Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY51680 Issued in CA

Legal business name

PROVIDENCE PHARMACEUTICALS INC

Practice address

15435 S Western Ave
Ste 100 C
Gardena, CA 90249-4323

Phone

(310) 353-2695

Fax

(310) 353-2696

NPI assigned

Aug 10, 2006

Organization subpart

No

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

Authorized official

Name

Diana ChoiNPI 1649671363

Title

President

Phone

(310) 353-2699

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Econo 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.

• Diana Choi

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Gardena, CA
  • NPI 1649671363
  NPD Authorized official

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487635200000",
    "number": "1639180227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15435 S WESTERN AVE",
            "address_2": "STE 100 C",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902494323",
            "telephone_number": "310-353-2695",
            "fax_number": "310-353-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15435 S WESTERN AVE",
            "address_2": "STE 100 C",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902494323",
            "telephone_number": "310-353-2695",
            "fax_number": "310-353-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PHARMACEUTICALS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2017-02-21",
        "status": "A",
        "authorized_official_last_name": "CHOI",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-353-2699"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY51680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143869",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Econo Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Gardena, CA
• Providers in Gardena, 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 21, 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.