Provider Demographics
NPI:1134219355
Name:ZZ FARMACY INC
Entity type:Organization
Organization Name:ZZ FARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-531-5502
Mailing Address - Street 1:14516 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5750
Mailing Address - Country:US
Mailing Address - Phone:714-531-5502
Mailing Address - Fax:714-531-8425
Practice Address - Street 1:14516 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5750
Practice Address - Country:US
Practice Address - Phone:714-531-5502
Practice Address - Fax:714-531-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY55898333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA390760Medicaid
CAPHA390760Medicaid
CAPHA390760Medicaid
WABB3359739OtherDEA