Provider Demographics
NPI:1962413542
Name:BOTICA EL MONTE
Entity type:Organization
Organization Name:BOTICA EL MONTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:ONGGOSUWARNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-579-6277
Mailing Address - Street 1:10808 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10808 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2628
Practice Address - Country:US
Practice Address - Phone:626-579-6277
Practice Address - Fax:626-579-6739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY432213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0537386OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0537386OtherOTHER ID NUMBER
CAPHA432210Medicaid
CAPHA432210Medicaid