Provider Demographics
NPI:1093751950
Name:FORTUNE PHARMACY INC
Entity Type:Organization
Organization Name:FORTUNE PHARMACY INC
Other - Org Name:ALHAMBRA PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KAM-YING
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:626-458-8909
Mailing Address - Street 1:330 S GARFIELD AVE
Mailing Address - Street 2:#104
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3892
Mailing Address - Country:US
Mailing Address - Phone:626-458-8909
Mailing Address - Fax:626-458-8950
Practice Address - Street 1:330 S GARFIELD AVE
Practice Address - Street 2:#104
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3892
Practice Address - Country:US
Practice Address - Phone:626-458-8909
Practice Address - Fax:626-458-8950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORTUNE PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY46885333600000X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA468850Medicaid
CAPHA468850Medicaid