Provider Demographics
NPI:1578871406
Name:ALPHA MEDICAL PHARMACY II
Entity Type:Organization
Organization Name:ALPHA MEDICAL PHARMACY II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:FAI
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-280-3131
Mailing Address - Street 1:1418 SOUTH SAN GABRIEL BLVD
Mailing Address - Street 2:#A
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776
Mailing Address - Country:US
Mailing Address - Phone:626-280-3131
Mailing Address - Fax:626-280-3138
Practice Address - Street 1:1418 S. SAN GABRIEL BLVD.,
Practice Address - Street 2:#A
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776
Practice Address - Country:US
Practice Address - Phone:626-280-3131
Practice Address - Fax:626-280-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578871406Medicaid