Provider Demographics
NPI:1821349341
Name:DANG PHARMACY GROUP INC
Entity Type:Organization
Organization Name:DANG PHARMACY GROUP INC
Other - Org Name:SAN GABRIEL MEDICAL COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PIC
Authorized Official - Prefix:
Authorized Official - First Name:THI
Authorized Official - Middle Name:
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-593-2428
Mailing Address - Street 1:1250 S SUNSET AVE
Mailing Address - Street 2:#207-B
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3961
Mailing Address - Country:US
Mailing Address - Phone:626-593-2428
Mailing Address - Fax:626-960-8749
Practice Address - Street 1:1250 S SUNSET AVE # 207-B
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3961
Practice Address - Country:US
Practice Address - Phone:626-593-2428
Practice Address - Fax:626-960-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY511973336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145475OtherPK