Provider Demographics
NPI:1487640488
Name:PHARMILYCARE INC
Entity Type:Organization
Organization Name:PHARMILYCARE INC
Other - Org Name:ROSA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOANG TRUNG
Authorized Official - Middle Name:XUAN
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:626-573-9477
Mailing Address - Street 1:9200 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1900
Mailing Address - Country:US
Mailing Address - Phone:626-573-9477
Mailing Address - Fax:626-573-8553
Practice Address - Street 1:9200 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1900
Practice Address - Country:US
Practice Address - Phone:626-573-9477
Practice Address - Fax:626-573-8553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-25
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY59129OtherBOARD OF PHARMACY
CAPHA415080Medicaid
CAPHA415080Medicaid