Provider Demographics
NPI:1578679577
Name:GLENDALE HAN KUK PHARMACY, INC
Entity Type:Organization
Organization Name:GLENDALE HAN KUK PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-637-7708
Mailing Address - Street 1:831 N PACIFIC AVE
Mailing Address - Street 2:SUITE #G
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3669
Mailing Address - Country:US
Mailing Address - Phone:818-637-7708
Mailing Address - Fax:818-637-7893
Practice Address - Street 1:831 N PACIFIC AVE
Practice Address - Street 2:SUITE #G
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3669
Practice Address - Country:US
Practice Address - Phone:818-637-7708
Practice Address - Fax:818-637-7893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY509273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA436610Medicaid
CA5510550001Medicare NSC