Provider Demographics
NPI:1598126591
Name:MEDPHACO INC
Entity Type:Organization
Organization Name:MEDPHACO INC
Other - Org Name:HEALTH FIRST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-236-5777
Mailing Address - Street 1:3010 W ORANGE AVE
Mailing Address - Street 2:#101
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3170
Mailing Address - Country:US
Mailing Address - Phone:714-236-5777
Mailing Address - Fax:714-236-5778
Practice Address - Street 1:3010 W ORANGE AVE
Practice Address - Street 2:#101
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3170
Practice Address - Country:US
Practice Address - Phone:714-236-5777
Practice Address - Fax:714-236-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54289333600000X
3336C0003X
CAPHY542893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159440OtherPK
2159440OtherPK
CA1598126591Medicaid