Look up the most recent NPI and PECOS records

Big A Drug Stores Inc

(Drug Emporium)

Pharmacy

Suppliers

13852 Red Hill Ave, Tustin, CA 92780-4637

PECOS Enrollment

Based on the most recent information from CMS, provider Big A Drug Stores Inc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:47 AM.

Profile Details

Provider ID
1154410702
Provider Type
Organization
Full Name
Big A Drug Stores Inc
Other Name
Drug Emporium

Subpart
No
Enumeration Date
10/12/2006
Last Updated
8/22/2020

Contact Information

Practice Location

13852 Red Hill Ave, Tustin, CA 92780-4637

(714) 544-4701

(714) 544-8076

Mailing Location

PO Box 31001, Pasadena, CA 91110-0001

Unlisted Phone

Unlisted Fax

Authorized Official

Dallal, Edward (President)

(562) 633-9578

Provider Taxonomies

Code	Description	License
Code 333600000X	Description Pharmacy Suppliers	License PHY45368 California
Code 3336C0003X	Description Pharmacy Suppliers	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID PHA453680	Description Medicaid	Issuer Unlisted California
ID 0582064	Description Other	Issuer OTHER ID NUMBER-COMMERCIAL NUMBER

Big A Drug Stores Inc

(Drug Emporium)

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

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