Provider Demographics
NPI:1497889752
Name:PACIFIC HEALTH INC
Entity Type:Organization
Organization Name:PACIFIC HEALTH INC
Other - Org Name:PHI PHARMACY I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:670-323-5000
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:
Mailing Address - Fax:670-323-5011
Practice Address - Street 1:KAGMAN COMMERCIAL BUILDING, UNIT D
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-235-6175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MPRP0013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MP3R007Medicaid
2112141OtherPK