=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821349341
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANG PHARMACY GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2012
-----------------------------------------------------
Last Update Date | 03/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1250 S SUNSET AVE # 207-B
-----------------------------------------------------
City | WEST COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91790-3961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-593-2428
-----------------------------------------------------
Fax | 626-960-8749
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1250 S SUNSET AVE #207-B
-----------------------------------------------------
City | WEST COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91790-3961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-593-2428
-----------------------------------------------------
Fax | 626-960-8749
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PIC
-----------------------------------------------------
Name | THI DANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-593-2428
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number | PHY51197
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------