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| Type | Company | [sources] | |||
|---|---|---|---|---|---|
| Name | 111 Pharmacy | [sources] | |||
| Incorporation date | not available | [sources] | |||
| Jurisdiction | not available | [sources] | |||
| Country | United States | [sources] | |||
| NPI | 1821137118 | [sources] | |||
| Registration number | 41023 · PHA393440 · PHA410230 | [sources] | |||
| Sector | Pharmacy/Pharmacist | [sources] | |||
| Address | 111 West Beverly Blvd., Ste. B, Montebello, CA, 90640 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States · DHCS
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