Provider Demographics
NPI:1376529701
Name:ANA PHARMACY CORPORATION
Entity Type:Organization
Organization Name:ANA PHARMACY CORPORATION
Other - Org Name:ANA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-530-3784
Mailing Address - Street 1:10191 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4752
Mailing Address - Country:US
Mailing Address - Phone:714-530-3784
Mailing Address - Fax:714-530-4037
Practice Address - Street 1:10191 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4752
Practice Address - Country:US
Practice Address - Phone:714-530-3784
Practice Address - Fax:714-530-4037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-18
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0501913OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA6091430001Medicare NSC