Provider Demographics
NPI:1023439957
Name:ABC MEDICINE INC
Entity type:Organization
Organization Name:ABC MEDICINE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-288-8744
Mailing Address - Street 1:7626 E CHAPMAN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-8532
Mailing Address - Country:US
Mailing Address - Phone:714-288-8744
Mailing Address - Fax:714-288-8745
Practice Address - Street 1:7626 E CHAPMAN AVE STE C
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-8532
Practice Address - Country:US
Practice Address - Phone:714-288-8744
Practice Address - Fax:714-288-8745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336S0011X
CAPHY517043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023439957Medicaid
2143459OtherPK
CB208839Medicare PIN
7118350001Medicare NSC