Provider Demographics
NPI:1053452227
Name:FRIENDLY HILLS MEDICAL CENTER PHARMACY INC
Entity Type:Organization
Organization Name:FRIENDLY HILLS MEDICAL CENTER PHARMACY INC
Other - Org Name:BRIGHT LA MIRADA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:562-777-8175
Mailing Address - Street 1:12675 LA MIRADA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2249
Mailing Address - Country:US
Mailing Address - Phone:562-777-8175
Mailing Address - Fax:562-777-7156
Practice Address - Street 1:12675 LA MIRADA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2249
Practice Address - Country:US
Practice Address - Phone:562-777-8175
Practice Address - Fax:562-777-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY447693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA447690Medicaid