Provider Demographics
NPI:1497572234
Name:FORTUNE PHARMACY INC
Entity type:Organization
Organization Name:FORTUNE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:KAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-458-8909
Mailing Address - Street 1:330 S GARFIELD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3893
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 S GARFIELD AVE STE 104
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3893
Practice Address - Country:US
Practice Address - Phone:626-458-8909
Practice Address - Fax:626-458-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy