Healthcare Provider Details

I. General information

NPI: 1700808649
Provider Name (Legal Business Name): PACIFIC PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S SANTA ANITA AVE SUITE G-10
SAN GABRIEL CA
91776-1146
US

IV. Provider business mailing address

207 S SANTA ANITA AVE STE. G-10
SAN GABRIEL CA
91776-1146
US

V. Phone/Fax

Practice location:
  • Phone: 626-281-6800
  • Fax: 626-281-6696
Mailing address:
  • Phone: 626-281-6800
  • Fax: 626-281-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHA467170
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHA467170
License Number StateCA

VIII. Authorized Official

Name: MRS. LYNN UNG
Title or Position: CEO
Credential: R. PH
Phone: 626-281-6800