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General NPI Number Information
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NPI Number | 1508094558
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Entity Type | Organization
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Legal Business Name | MODERNHEALTH HOLDINGS INC
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 13220 EVENING CREEK DR S STE 110
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City | SAN DIEGO
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State | CA
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Zip | 92128-4103
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Country | US
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Telephone | 858-668-3350
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Fax | 858-668-3352
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Provider Business Mailing Address
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Address Line | 110 E HUNTINGTON DR
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City | MONROVIA
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State | CA
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Zip | 91016-3415
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Country | US
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Telephone | 858-668-3350
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Fax | 858-668-3352
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Authorized Official
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Title or Position | DIRECTOR, BUSINESS OPERATIONS
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Name | SHANNON CHOU
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Credential |
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Telephone | 626-932-1721
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY51002
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License Number State | CA
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