Active NPI
Patricia Mae Bulosan Ilao, PHARMD
- Pharmacist
- Redondo Beach, CA
National Provider Identifier
1669219952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 87500
- Practice address
- 316 S Pacific Coast Hwy
Redondo Beach, CA 90277-3729 - Phone
- (310) 540-9183
- NPI assigned
- Jul 12, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 87500 | CA | Primary |
Addresses
Primary practice location
316 S Pacific Coast Hwy
Redondo Beach, CA 90277-3729
Mailing address
12025 Courser Ave
La Mirada, CA 90638-1420
Phone (562) 458-4989
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 87500 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Garfield Beach CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Jurupa Valley, CA
- NPI 1780573113
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723507200000",
"number": "1669219952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12025 COURSER AVE",
"city": "LA MIRADA",
"state": "CA",
"postal_code": "906381420",
"telephone_number": "562-458-4989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "316 S PACIFIC COAST HWY",
"city": "REDONDO BEACH",
"state": "CA",
"postal_code": "902773729",
"telephone_number": "310-540-9183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILAO",
"first_name": "PATRICIA MAE",
"middle_name": "BULOSAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-12",
"last_updated": "2024-08-13",
"certification_date": "2024-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "87500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redondo Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.