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NPI Code Detail

MEDICARE: PRIME RX SAN GABRIEL, INC.

MEDICARE: PRIME RX SAN GABRIEL, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1114532231
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIME RX SAN GABRIEL, INC.
Provider Business Mailing Address
First Line : 533 W LAS TUNAS DR # 102
Second Line :
City : SAN GABRIEL
State : CA
Zip : 91776-1133
Country : US
Telephone Number : 213-234-8319
Fax Number :
Provider Business Practice Location Address
First Line : 533 W LAS TUNAS DR # 102
Second Line :
City : SAN GABRIEL
State : CA
Zip : 91776-1133
Country : US
Telephone Number : 626-656-6939
Fax Number : 626-656-6593
Authorized Official
Title or Position : CEO
Name : DONALD HAN
Credential :
Telephone Number : 626-656-6939
Provider Enumeration Date : 09/15/2020
Last Update Date : 06/17/2025

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Directions to “PRIME RX SAN GABRIEL, INC. ” Practice Location

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