Provider Demographics
NPI:1013301308
Name:DRAGON PHARMACY CORP
Entity type:Organization
Organization Name:DRAGON PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:714-927-7871
Mailing Address - Street 1:5839 WESTMINSTER BLVD
Mailing Address - Street 2:#A
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-9107
Mailing Address - Country:US
Mailing Address - Phone:714-927-7871
Mailing Address - Fax:714-927-7840
Practice Address - Street 1:5839 WESTMINSTER BLVD
Practice Address - Street 2:#A
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-9107
Practice Address - Country:US
Practice Address - Phone:714-927-7871
Practice Address - Fax:714-927-7840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7379780001Medicare NSC