Provider Demographics
NPI:1821072596
Name:EKH INC
Entity Type:Organization
Organization Name:EKH INC
Other - Org Name:ST. PAUL'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:M
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-567-4803
Mailing Address - Street 1:3819 TWEEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6101
Mailing Address - Country:US
Mailing Address - Phone:323-567-4803
Mailing Address - Fax:323-357-1920
Practice Address - Street 1:3819 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6101
Practice Address - Country:US
Practice Address - Phone:323-567-4803
Practice Address - Fax:323-357-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY44785333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821072596Medicaid
CA5195690001Medicare NSC