Provider Demographics
NPI:1235602996
Name:HMS PHARMACY, INC
Entity Type:Organization
Organization Name:HMS PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-995-0071
Mailing Address - Street 1:2795 W LINCOLN AVE STE K
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6334
Mailing Address - Country:US
Mailing Address - Phone:714-995-0071
Mailing Address - Fax:714-995-0102
Practice Address - Street 1:2795 W LINCOLN AVE STE K
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6334
Practice Address - Country:US
Practice Address - Phone:714-995-0071
Practice Address - Fax:714-995-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-05
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235602996Medicaid