Provider Demographics
NPI:1629103569
Name:AZALEA HEALTHCARE INC
Entity Type:Organization
Organization Name:AZALEA HEALTHCARE INC
Other - Org Name:986 PHARMACY #8012
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PHUING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-281-9913
Mailing Address - Street 1:1 E VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5115
Mailing Address - Country:US
Mailing Address - Phone:626-281-9913
Mailing Address - Fax:626-281-9392
Practice Address - Street 1:1 E VALLEY BVLD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5115
Practice Address - Country:US
Practice Address - Phone:626-281-9913
Practice Address - Fax:626-281-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5456400001Medicare NSC