MEDICARE: NORMANDY HEALTHCARE 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	3336C0003X	Community/Retail Pharmacy	50625	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	2130255	OTHER		PK

General Provider Information

NPI Number	:	1629083274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORMANDY HEALTHCARE INC

Provider Business Mailing Address
First Line	:	2476 HUNTINGTON DR
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2643
Country	:	US
Telephone Number	:	626-399-0278
Fax Number	:	626-399-0421

Provider Business Practice Location Address
First Line	:	3003 W OLYMPIC BLVD
Second Line	:	STE 101
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-6500
Country	:	US
Telephone Number	:	213-386-3001
Fax Number	:	213-386-1416

Authorized Official
Title or Position	:	CEO
Name	:	KHANH-LONG THAI
Credential	:	PHARM D
Telephone Number	:	213-386-3001

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	06/11/2026

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Directions to “NORMANDY HEALTHCARE INC ” Practice Location

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