1663 Pharmacy Inc

Primary specialty

PharmacistTaxonomy code 183500000X

License

31852 Issued in CA

Legal business name

1663 PHARMACY INC

Practice address

1663 Beverly Blvd
Los Angeles, CA 90026-5710

Phone

(213) 250-7229

Fax

(213) 250-0439

NPI assigned

Dec 18, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Teodoro Reyes SantosNPI 1497865570

Title

Pharmacist

Phone

(213) 250-7229

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Teodoro Reyes Santos

  • Pharmacist
  • Los Angeles, CA
  • NPI 1497865570
  NPD (past) Authorized official

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740343433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1663 BEVERLY BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900265710",
            "telephone_number": "213-250-7229",
            "fax_number": "213-250-0439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1663 BEVERLY BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900265710",
            "telephone_number": "213-250-7229",
            "fax_number": "213-250-0439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1663 PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SANTOS",
        "authorized_official_first_name": "TEODORO",
        "authorized_official_middle_name": "REYES",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "213-250-7229",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "31852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1497865570",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "0573445",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHY229000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.