Provider Demographics
NPI:1801137195
Name:EZ PHARMACY
Entity type:Organization
Organization Name:EZ PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:626-872-0750
Mailing Address - Street 1:625 E VALLEY BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3591
Mailing Address - Country:US
Mailing Address - Phone:626-872-0750
Mailing Address - Fax:626-872-0752
Practice Address - Street 1:625 E VALLEY BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3591
Practice Address - Country:US
Practice Address - Phone:626-872-0750
Practice Address - Fax:626-872-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8167740Medicaid