Infortel Medical Group

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY 50343 Issued in CA

Legal business name

INFORTEL MEDICAL GROUP

Doing business as

Station Pharmacy

Practice address

1820 Wilshire Blvd
Santa Monica, CA 90403-5610

Phone

(310) 892-0468

Fax

(310) 861-1888

NPI assigned

Jul 20, 2010

Last updated

Feb 3, 2015By 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

Ms. Eleanor Fam Mai Kong, PHARM DNPI 1336356278

Title

President/Pic

Phone

(310) 892-0468

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• STATION PHARMACY Doing business as

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.

• Eleanor F Kong, PHARM.D.

  • Nutrition Support Pharmacist
  • Santa Monica, CA
  • NPI 1336356278
  Authorized official Same address or phone

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

{
    "created_epoch": "1279584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422921600000",
    "number": "1780997619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 WILSHIRE BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035610",
            "telephone_number": "310-892-0468",
            "fax_number": "310-861-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 WILSHIRE BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035610",
            "telephone_number": "310-892-0468",
            "fax_number": "310-861-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFORTEL MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-20",
        "last_updated": "2015-02-03",
        "status": "A",
        "authorized_official_last_name": "KONG",
        "authorized_official_first_name": "ELEANOR",
        "authorized_official_middle_name": "FAM MAI",
        "authorized_official_title_or_position": "PRESIDENT/PIC",
        "authorized_official_telephone_number": "310-892-0468",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "PHY 50343",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY 50343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAILFORNIA STATE BOARD OF PHARMACY",
            "identifier": "PHY 50343",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA465390",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STATION PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Santa Monica, CA
• Providers in Santa Monica, 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 3, 2015; 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.