Provider Demographics
NPI:1952843559
Name:MOLINO PHARMACY INC
Entity Type:Organization
Organization Name:MOLINO PHARMACY INC
Other - Org Name:MOLINO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-433-4900
Mailing Address - Street 1:2875 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2220
Mailing Address - Country:US
Mailing Address - Phone:562-433-4900
Mailing Address - Fax:562-433-7050
Practice Address - Street 1:2540 E ANAHEIM ST # B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3607
Practice Address - Country:US
Practice Address - Phone:562-433-4900
Practice Address - Fax:562-433-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0002X, 3336C0003X, 3336C0004X
CAPHY54954333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166186OtherPK