Healthcare Provider Details

I. General information

NPI: 1790158350
Provider Name (Legal Business Name): EMERALD HEALTHCARE PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3414 W BEVERLY BLVD
MONTEBELLO CA
90640-1539
US

IV. Provider business mailing address

3414 W BEVERLY BLVD
MONTEBELLO CA
90640-1539
US

V. Phone/Fax

Practice location:
  • Phone: 323-597-1188
  • Fax:
Mailing address:
  • Phone: 323-597-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number53284
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GEORGE CHU
Title or Position: PRESIDENT
Credential:
Phone: 626-863-5674