Provider Demographics
NPI:1093023822
Name:ROYAL PHARMACY
Entity Type:Organization
Organization Name:ROYAL PHARMACY
Other - Org Name:ROYAL PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-794-0380
Mailing Address - Street 1:1111 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2014
Mailing Address - Country:US
Mailing Address - Phone:650-794-0380
Mailing Address - Fax:650-794-0300
Practice Address - Street 1:1111 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-2014
Practice Address - Country:US
Practice Address - Phone:650-794-0380
Practice Address - Fax:650-794-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY503333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5639135OtherNCPDP PROVIDER IDENTIFICATION NUMBER