MEDICARE: PHNOM PICH PHARMACY 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	PHY48907	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1992188	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295805430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHNOM PICH PHARMACY INC

Provider Business Mailing Address
First Line	:	2338 E ANAHEIM ST
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90804-5730
Country	:	US
Telephone Number	:	562-438-3324
Fax Number	:	562-987-1801

Provider Business Practice Location Address
First Line	:	2338 E ANAHEIM ST
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90804-5730
Country	:	US
Telephone Number	:	562-438-3324
Fax Number	:	562-987-1801

Authorized Official
Title or Position	:	SECRETARY
Name	:	PUTHIK SANUI
Credential	:
Telephone Number	:	562-438-3324

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	09/19/2025

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