986 Specialty Pharmacy Pasadena Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

986 SPECIALTY PHARMACY PASADENA INC

Practice address

1719 E. Walnut St.
Pasadena, CA 91106-1611

Phone

(626) 798-6789

Fax

(626) 798-8376

NPI assigned

Sep 22, 2006

Last updated

Sep 29, 2021By 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. Simon Chan

Title

VP

Phone

(626) 798-6789

Specialties & licenses 1

Addresses

Other names 1

• Mary's Pharmacy Inc Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA4 enrollments

Enrollment records 4

Locations

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632873600000",
    "number": "1831299874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1719 E. WALNUT ST.",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911061611",
            "telephone_number": "626-798-6789",
            "fax_number": "626-798-8376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 E. WALNUT ST.",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911061611",
            "telephone_number": "626-798-6789",
            "fax_number": "626-798-8376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "986 SPECIALTY PHARMACY PASADENA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "626-798-6789",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary's Pharmacy Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• 986 Specialty Pharmacy Pasadena Inc
• 986 Specialty Pharmacy Pasadena Inc
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• A Better Life

• Community/Retail Pharmacy in Pasadena, CA
• Providers in Pasadena, 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 Sep 29, 2021; 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.