Provider Demographics
NPI:1215769609
Name:ILLUMINATE HEALTH INC
Entity type:Organization
Organization Name:ILLUMINATE HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-522-1013
Mailing Address - Street 1:3948 PECK RD # A9
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-2255
Mailing Address - Country:US
Mailing Address - Phone:626-522-1013
Mailing Address - Fax:626-995-1550
Practice Address - Street 1:3948 PECK RD # A9
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-2255
Practice Address - Country:US
Practice Address - Phone:626-522-1013
Practice Address - Fax:626-995-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy