Provider Demographics
NPI:1477674869
Name:PACIFIC HEALTH INC
Entity Type:Organization
Organization Name:PACIFIC HEALTH INC
Other - Org Name:PHI PHARMACY II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:670-235-6175
Mailing Address - Street 1:PO BOX 505089
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-4314
Mailing Address - Country:US
Mailing Address - Phone:670-235-6175
Mailing Address - Fax:670-235-6180
Practice Address - Street 1:JOETEN DANDAN CENTER, MNSGR GUERRERO RD., DANDAN
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-235-6174
Practice Address - Fax:670-235-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MPRP0033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2112142OtherPK