Provider Demographics
NPI:1447625769
Name:MED CHOICE PHARMACY INC
Entity type:Organization
Organization Name:MED CHOICE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDNET/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:N
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-533-3080
Mailing Address - Street 1:621 N EUCLID ST
Mailing Address - Street 2:B
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4615
Mailing Address - Country:US
Mailing Address - Phone:714-533-3080
Mailing Address - Fax:714-533-3090
Practice Address - Street 1:621 N EUCLID ST
Practice Address - Street 2:B
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4615
Practice Address - Country:US
Practice Address - Phone:714-533-3080
Practice Address - Fax:714-533-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 538463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 53846OtherSTATE BOARD OF PHARMACY PERMIT
CA7523580001Medicare NSC