Provider Demographics
NPI:1205988094
Name:HOUSE OF MEDICINE INC
Entity type:Organization
Organization Name:HOUSE OF MEDICINE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:HAHMUD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-520-9085
Mailing Address - Street 1:2530 BRENNEN WAY
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 N HARBOR BLVD
Practice Address - Street 2:STE 136
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2400
Practice Address - Country:US
Practice Address - Phone:714-520-9085
Practice Address - Fax:714-517-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY444683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0544266OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA44468Medicaid
4761370001Medicare NSC