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General NPI Number Information
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NPI Number | 1205988094
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Entity Type | Organization
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Legal Business Name | HOUSE OF MEDICINE INC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 1150 N HARBOR BLVD STE 136
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City | ANAHEIM
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State | CA
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Zip | 92801-2400
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Country | US
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Telephone | 714-520-9085
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Fax | 714-517-0400
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Provider Business Mailing Address
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Address Line | 2530 BRENNEN WAY
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City | FULLERTON
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State | CA
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Zip | 92835-4217
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | HAHMUD LEBADA
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Credential |
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Telephone | 714-520-9085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY44468
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License Number State | CA
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