Provider Demographics
NPI:1972615961
Name:C D HEALTHCARE INC
Entity Type:Organization
Organization Name:C D HEALTHCARE INC
Other - Org Name:GARFIELD MEDICAL SQUARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-288-6120
Mailing Address - Street 1:500 N GARFIELD AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1242
Mailing Address - Country:US
Mailing Address - Phone:626-288-6120
Mailing Address - Fax:626-288-2076
Practice Address - Street 1:500 N GARFIELD AVE STE 103
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1242
Practice Address - Country:US
Practice Address - Phone:626-288-6120
Practice Address - Fax:626-288-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
CAPHY437503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2003153OtherPK
CAPHA437500Medicaid
0525684OtherOTHER ID NUMBER-COMMERCIAL NUMBER