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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1780405514
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 BLVD
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 PHUONG
Credential	:
Telephone Number	:	626-399-0278

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	10/23/2024

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Directions to “AZALEA HEALTHCARE INC ” Practice Location

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