Provider Demographics
NPI:1376553297
Name:HP BADESHA CO
Entity Type:Organization
Organization Name:HP BADESHA CO
Other - Org Name:GLENDORA MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PARAMJIT
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:RANDHAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-335-0288
Mailing Address - Street 1:130 W ROUTE 66 STE 104
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6250
Mailing Address - Country:US
Mailing Address - Phone:626-335-0288
Mailing Address - Fax:626-335-1487
Practice Address - Street 1:130 W ROUTE 66 STE 104
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6250
Practice Address - Country:US
Practice Address - Phone:626-335-0288
Practice Address - Fax:626-335-1487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY475173336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA475170Medicaid
1996062OtherPK
CA5728480001Medicare NSC