Provider Demographics
NPI:1790140721
Name:MHK PHARMACY CORPORATION
Entity Type:Organization
Organization Name:MHK PHARMACY CORPORATION
Other - Org Name:986 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KHANH-LONG
Authorized Official - Middle Name:
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-309-5052
Mailing Address - Street 1:9612 LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2108
Mailing Address - Country:US
Mailing Address - Phone:626-309-5052
Mailing Address - Fax:626-309-5042
Practice Address - Street 1:9612 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2108
Practice Address - Country:US
Practice Address - Phone:626-309-5052
Practice Address - Fax:626-309-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY537903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157318OtherPK