Healthcare Provider Details

I. General information

NPI: 1093751950
Provider Name (Legal Business Name): FORTUNE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S GARFIELD AVE #104
ALHAMBRA CA
91801-3892
US

IV. Provider business mailing address

330 S GARFIELD AVE #104
ALHAMBRA CA
91801-3892
US

V. Phone/Fax

Practice location:
  • Phone: 626-458-8909
  • Fax: 626-458-8950
Mailing address:
  • Phone: 626-458-8909
  • Fax: 626-458-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY46885
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHY46885
License Number StateCA

VIII. Authorized Official

Name: KAM-YING GUO
Title or Position: PHARMACIST
Credential: R.PH
Phone: 626-458-8909