Healthcare Provider Details

I. General information

NPI: 1093023822
Provider Name (Legal Business Name): ROYAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 EL CAMINO REAL
MILLBRAE CA
94030-2014
US

IV. Provider business mailing address

1111 EL CAMINO REAL
MILLBRAE CA
94030-2014
US

V. Phone/Fax

Practice location:
  • Phone: 650-794-0380
  • Fax: 650-794-0300
Mailing address:
  • Phone: 650-794-0380
  • Fax: 650-794-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50333
License Number StateCA

VIII. Authorized Official

Name: ERIC WONG
Title or Position: PRESIDENT/PIC
Credential:
Phone: 650-794-0380