Provider Demographics
NPI:1467467076
Name:UNITED PHARMACEUTICAL
Entity Type:Organization
Organization Name:UNITED PHARMACEUTICAL
Other - Org Name:XUANS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:K
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-531-2757
Mailing Address - Street 1:10495 BOLSA AVE SUITE # 102
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6762
Mailing Address - Country:US
Mailing Address - Phone:714-531-2757
Mailing Address - Fax:714-531-1390
Practice Address - Street 1:10495 BOLSA AVE SUITE # 102
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6762
Practice Address - Country:US
Practice Address - Phone:714-531-2757
Practice Address - Fax:714-531-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1467467076Medicaid
CA1467467076Medicaid
CA1467467076Medicaid