Provider Demographics
NPI:1588019491
Name:PHARMACY PLUS INC
Entity Type:Organization
Organization Name:PHARMACY PLUS INC
Other - Org Name:PHARMACY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KWANG JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-956-3741
Mailing Address - Street 1:1012 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3634
Mailing Address - Country:US
Mailing Address - Phone:714-956-3741
Mailing Address - Fax:714-956-5249
Practice Address - Street 1:1012 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3634
Practice Address - Country:US
Practice Address - Phone:714-956-3741
Practice Address - Fax:714-956-5249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY542953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA487520Medicaid
2159726OtherPK
CAPHA487520Medicaid