Healthcare Provider Details

I. General information

NPI: 1689717175
Provider Name (Legal Business Name): EDDAN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N MAIN ST
SANTA ANA CA
92701-4620
US

IV. Provider business mailing address

510 N MAIN ST
SANTA ANA CA
92701-4620
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-5444
  • Fax:
Mailing address:
  • Phone: 714-542-5444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH39609
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRPH39609
License Number StateCA

VIII. Authorized Official

Name: DR. DANIEL D SU
Title or Position: CEO
Credential: PHARM D.
Phone: 714-542-5444