Provider Demographics
NPI:1639171432
Name:HEALTHCARE MEDICAL PHARMACY INC
Entity Type:Organization
Organization Name:HEALTHCARE MEDICAL PHARMACY INC
Other - Org Name:HEALTHCARE MEDICAL PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:626-573-4513
Mailing Address - Street 1:420 N GARFIELD AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1206
Mailing Address - Country:US
Mailing Address - Phone:626-573-4513
Mailing Address - Fax:626-573-9897
Practice Address - Street 1:420 N GARFIELD AVE
Practice Address - Street 2:STE 101
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1206
Practice Address - Country:US
Practice Address - Phone:626-573-4513
Practice Address - Fax:626-573-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA394310Medicaid
0543567OtherNCPDP
CAPHA394310Medicaid