Provider Demographics
NPI:1114786241
Name:ANAHEIM PHARMACY, LLC
Entity Type:Organization
Organization Name:ANAHEIM PHARMACY, LLC
Other - Org Name:ANAHEIM PHARMACY (LTC)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-464-0300
Mailing Address - Street 1:1211 W LA PALMA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2809
Mailing Address - Country:US
Mailing Address - Phone:714-442-1141
Mailing Address - Fax:714-442-1142
Practice Address - Street 1:1211 W LA PALMA AVE STE 102
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2809
Practice Address - Country:US
Practice Address - Phone:714-442-1141
Practice Address - Fax:714-442-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy