Provider Demographics
NPI:1396026316
Name:MOC & PATEL
Entity Type:Organization
Organization Name:MOC & PATEL
Other - Org Name:HEIDI'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-333-7878
Mailing Address - Street 1:3150 COLIMA RD STE B
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6356
Mailing Address - Country:US
Mailing Address - Phone:626-333-7878
Mailing Address - Fax:626-333-7171
Practice Address - Street 1:3150 COLIMA RD STE B
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6356
Practice Address - Country:US
Practice Address - Phone:626-333-7878
Practice Address - Fax:626-333-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-03
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY506843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396026316Medicaid
2131792OtherPK