MEDICARE: AZALEA 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1629103569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZALEA HEALTHCARE INC

Provider Business Mailing Address
First Line	:	1 E VALLEY BLVD
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91801-5115
Country	:	US
Telephone Number	:	626-281-9913
Fax Number	:	626-281-9392

Provider Business Practice Location Address
First Line	:	1 E VALLEY BVLD
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91801-5115
Country	:	US
Telephone Number	:	626-281-9913
Fax Number	:	626-281-9392

Authorized Official
Title or Position	:	CEO
Name	:	TRACY B PHUING
Credential	:
Telephone Number	:	626-281-9913

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/05/2023

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Directions to “AZALEA HEALTHCARE INC ” Practice Location

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