Provider Demographics
NPI:1386799419
Name:BERTA P CHOY
Entity type:Organization
Organization Name:BERTA P CHOY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-262-8230
Mailing Address - Street 1:PO BOX 544
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91031-0544
Mailing Address - Country:US
Mailing Address - Phone:323-262-8230
Mailing Address - Fax:323-262-8395
Practice Address - Street 1:4055 E OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-3345
Practice Address - Country:US
Practice Address - Phone:323-262-8230
Practice Address - Fax:323-262-8395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY391213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0541020OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA391210Medicaid
0541020OtherNCPDP PROVIDER IDENTIFICATION NUMBER