Provider Demographics
NPI:1336430867
Name:CHC GROUP INC
Entity Type:Organization
Organization Name:CHC GROUP INC
Other - Org Name:WHITE CROSS PHARMACY #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:HO
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-322-6700
Mailing Address - Street 1:1717 E VISTA CHINO STE B2
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-3569
Mailing Address - Country:US
Mailing Address - Phone:760-322-6700
Mailing Address - Fax:760-322-2266
Practice Address - Street 1:1717 E VISTA CHINO STE B2
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-322-6700
Practice Address - Fax:760-322-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130189OtherPK
5640897OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA1336430867Medicaid