Provider Demographics
NPI:1043292782
Name:FRIEND RX, INC
Entity type:Organization
Organization Name:FRIEND RX, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHUNG
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-995-0071
Mailing Address - Street 1:2795 W LINCOLN AVE
Mailing Address - Street 2:#K
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6334
Mailing Address - Country:US
Mailing Address - Phone:714-995-0071
Mailing Address - Fax:714-995-0102
Practice Address - Street 1:2795 W LINCOLN AVE
Practice Address - Street 2:#K
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6334
Practice Address - Country:US
Practice Address - Phone:714-995-0071
Practice Address - Fax:714-995-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50282333600000X
CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0537538OtherNCPDP #
CA1043292782Medicaid
CAPHY50282OtherPHARMACY LICENCE
CAPHY50282OtherPHARMACY LICENCE