Provider Demographics
NPI:1821322082
Name:BAXCO PHARMACEUTICAL, INC.
Entity Type:Organization
Organization Name:BAXCO PHARMACEUTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-688-9138
Mailing Address - Street 1:205 LEMON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2643
Mailing Address - Country:US
Mailing Address - Phone:909-595-0826
Mailing Address - Fax:909-595-6600
Practice Address - Street 1:205 LEMON CREEK DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2643
Practice Address - Country:US
Practice Address - Phone:909-595-0826
Practice Address - Fax:909-595-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization