Provider Demographics
NPI:1619988292
Name:LUCKY HEALTH INC
Entity Type:Organization
Organization Name:LUCKY HEALTH INC
Other - Org Name:LUCKY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:SHIU FONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:626-447-3888
Mailing Address - Street 1:1108 S BALDWIN AVE
Mailing Address - Street 2:STORE NUMBER 8 & 9
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7508
Mailing Address - Country:US
Mailing Address - Phone:626-447-3888
Mailing Address - Fax:626-869-1802
Practice Address - Street 1:1108 S BALDWIN AVE
Practice Address - Street 2:STORE NUMBER 8 & 9
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7508
Practice Address - Country:US
Practice Address - Phone:626-447-3888
Practice Address - Fax:626-869-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 520633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-12675OtherNCPDP NUMBER
CAPHY 52063OtherBOARD OF PHARMACY PERMIT