Provider Demographics
NPI:1750634192
Name:CNC PHARMACY INC
Entity Type:Organization
Organization Name:CNC PHARMACY INC
Other - Org Name:EXCLUSIVE MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHHEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-578-9991
Mailing Address - Street 1:65 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101
Mailing Address - Country:US
Mailing Address - Phone:626-578-9991
Mailing Address - Fax:626-578-9992
Practice Address - Street 1:65 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-578-9991
Practice Address - Fax:626-578-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY51082333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1750634192Medicaid
2137691OtherPK