Provider Demographics
NPI:1104800457
Name:PASEO PHARMACY LTD
Entity type:Organization
Organization Name:PASEO PHARMACY LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAROUGHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-564-1000
Mailing Address - Street 1:2237 E COLORADO BLVD
Mailing Address - Street 2:B104
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3650
Mailing Address - Country:US
Mailing Address - Phone:626-564-1001
Mailing Address - Fax:626-583-8833
Practice Address - Street 1:2237 E COLORADO BLVD
Practice Address - Street 2:B104
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3650
Practice Address - Country:US
Practice Address - Phone:626-564-1000
Practice Address - Fax:626-583-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 519073336C0004X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding PharmacyGroup - Single Specialty
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-66325OtherNCPDP
CAPHY 51907OtherBOARD OF PHARMACY PERMIT