Provider Demographics
NPI:1861864092
Name:HAN, CINDY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9920 GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-1230
Mailing Address - Country:US
Mailing Address - Phone:626-443-3097
Mailing Address - Fax:626-448-5460
Practice Address - Street 1:9920 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1230
Practice Address - Country:US
Practice Address - Phone:626-443-3097
Practice Address - Fax:626-448-5460
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist