Provider Demographics
NPI:1114532231
Name:PRIME RX SAN GABRIEL, INC.
Entity Type:Organization
Organization Name:PRIME RX SAN GABRIEL, INC.
Other - Org Name:PRIME RX SAN GABRIEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-656-6939
Mailing Address - Street 1:533 W LAS TUNAS DR # 102
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1133
Mailing Address - Country:US
Mailing Address - Phone:213-234-8319
Mailing Address - Fax:
Practice Address - Street 1:533 W LAS TUNAS DR # 102
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1133
Practice Address - Country:US
Practice Address - Phone:626-656-6939
Practice Address - Fax:626-656-6593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy