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111 Pharmacy

Debarred entity
TypeCompany[sources]
Name111 Pharmacy[sources]
Incorporation datenot available[sources]
Jurisdictionnot available[sources]
CountryUnited States[sources]
DescriptionLicense number(s): 41023 · Provider number(s): PHA410230, PHA393440, 1821137118[sources]
Registration numbernot available[sources]
SectorPharmacy/Pharmacist[sources]
Address111 West Beverly Blvd., Ste. B, Montebello, CA, 90640[sources]
Last changeLast processedFirst seen

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Data sources

US California Medicaid Suspended and ineligible providers22,466

Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.

United States · DHCS


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