Provider Demographics
NPI:1902811524
Name:SPRING PARK PHARMACY INC
Entity Type:Organization
Organization Name:SPRING PARK PHARMACY INC
Other - Org Name:SPRING PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:562-420-1303
Mailing Address - Street 1:6226 E SPRING ST STE 140
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1441
Mailing Address - Country:US
Mailing Address - Phone:310-420-1303
Mailing Address - Fax:310-429-9271
Practice Address - Street 1:6226 E SPRING ST STE 140
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1441
Practice Address - Country:US
Practice Address - Phone:562-420-1303
Practice Address - Fax:562-429-9271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY368923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0505670OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA368920Medicaid
0505670OtherNCPDP PROVIDER IDENTIFICATION NUMBER