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General NPI Number Information
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NPI Number | 1578679577
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Entity Type | Organization
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Legal Business Name | GLENDALE HAN KUK PHARMACY, INC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 07/03/2012
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Provider Practice Location Address
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Address Line | 831 N PACIFIC AVE SUITE #G
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City | GLENDALE
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State | CA
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Zip | 91203-3669
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Country | US
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Telephone | 818-637-7708
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Fax | 818-637-7893
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Provider Business Mailing Address
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Address Line | 831 N PACIFIC AVE SUITE #G
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City | GLENDALE
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State | CA
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Zip | 91203-3669
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Country | US
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Telephone | 818-637-7708
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Fax | 818-637-7893
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Authorized Official
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Title or Position | C.E.O
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Name | SUSAN R. YOO
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Credential | RPH
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Telephone | 818-637-7708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY50927
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License Number State | CA
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