Healthcare Provider Details

I. General information

NPI: 1598126591
Provider Name (Legal Business Name): MEDPHACO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 W ORANGE AVE #101
ANAHEIM CA
92804-3170
US

IV. Provider business mailing address

3010 W ORANGE AVE #101
ANAHEIM CA
92804-3170
US

V. Phone/Fax

Practice location:
  • Phone: 714-236-5777
  • Fax: 714-236-5778
Mailing address:
  • Phone: 714-236-5777
  • Fax: 714-236-5778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number54289
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN LUU
Title or Position: PRESIDENT/CEO/RPH
Credential:
Phone: 714-236-5777