Provider Demographics
NPI:1811980253
Name:FRIENDLY HILLS MEDICAL CENTER PHARMACY INC.
Entity type:Organization
Organization Name:FRIENDLY HILLS MEDICAL CENTER PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:562-943-7500
Mailing Address - Street 1:15725 E WHITTIER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2343
Mailing Address - Country:US
Mailing Address - Phone:562-943-7500
Mailing Address - Fax:562-947-0446
Practice Address - Street 1:15725 E WHITTIER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2343
Practice Address - Country:US
Practice Address - Phone:562-943-7500
Practice Address - Fax:562-947-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY456323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA456320Medicaid
CA1214660002Medicare NSC