Provider Demographics
NPI:1114021169
Name:CN HEALTH INC
Entity Type:Organization
Organization Name:CN HEALTH INC
Other - Org Name:MEDNIK PHARMACY AND MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:323-288-9979
Mailing Address - Street 1:609 N MEDNIK AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1326
Mailing Address - Country:US
Mailing Address - Phone:323-268-9979
Mailing Address - Fax:323-268-9539
Practice Address - Street 1:609 N MEDNIK AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1326
Practice Address - Country:US
Practice Address - Phone:323-268-9979
Practice Address - Fax:323-268-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY485383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0586606OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA416180Medicaid
0586606OtherNCPDP PROVIDER IDENTIFICATION NUMBER