Provider Demographics
NPI:1730163403
Name:FAMILY PHARMACY
Entity type:Organization
Organization Name:FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMHUE
Authorized Official - Middle Name:THI
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-534-7656
Mailing Address - Street 1:10240 WESTMINSTER AVE
Mailing Address - Street 2:SUITE #104
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4855
Mailing Address - Country:US
Mailing Address - Phone:714-534-7656
Mailing Address - Fax:714-534-4424
Practice Address - Street 1:10240 WESTMINSTER AVE
Practice Address - Street 2:SUITE #104
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4855
Practice Address - Country:US
Practice Address - Phone:714-534-7656
Practice Address - Fax:714-534-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY36119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA361190Medicaid
CA3857000001Medicare ID - Type Unspecified
CAPHA361190Medicaid