Provider Demographics
NPI:1235203753
Name:G & H RAPHA INC
Entity Type:Organization
Organization Name:G & H RAPHA INC
Other - Org Name:PHARMACY EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, SEC AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:951-683-2172
Mailing Address - Street 1:5575 MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-4503
Mailing Address - Country:US
Mailing Address - Phone:951-683-2172
Mailing Address - Fax:951-683-2183
Practice Address - Street 1:5575 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-4503
Practice Address - Country:US
Practice Address - Phone:951-683-2172
Practice Address - Fax:951-683-2183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
CAPHY457623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA457620Medicaid
1992087OtherPK
CAPHA457620Medicaid