MEDICARE: DDE RX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY46526	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2112492	OTHER		PK

General Provider Information

NPI Number	:	1245345297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DDE RX INC

Provider Business Mailing Address
First Line	:	18491 COLIMA RD
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2805
Country	:	US
Telephone Number	:	626-581-3133
Fax Number	:	626-581-4422

Provider Business Practice Location Address
First Line	:	18491 COLIMA RD
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2805
Country	:	US
Telephone Number	:	626-581-3133
Fax Number	:	626-581-4422

Authorized Official
Title or Position	:	OWNER
Name	:	DING MEE NGUI
Credential	:
Telephone Number	:	626-581-3133

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	01/27/2022

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Directions to “DDE RX INC ” Practice Location

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