Provider Demographics
NPI:1306205380
Name:MEDELLA PHARMACY INC
Entity Type:Organization
Organization Name:MEDELLA PHARMACY INC
Other - Org Name:MEDELLA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ PHARMACIST IN CHARGE
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:626-333-1998
Mailing Address - Street 1:15578 GALE AVE
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-1513
Mailing Address - Country:US
Mailing Address - Phone:626-333-1998
Mailing Address - Fax:626-333-1668
Practice Address - Street 1:15578 GALE AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1513
Practice Address - Country:US
Practice Address - Phone:626-333-1998
Practice Address - Fax:626-333-1668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 541633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 54163OtherBOARD OF PHARMACY RETAIL PERMIT