Provider Demographics
NPI:1366084063
Name:PONTUS HEALTHCARE INC
Entity type:Organization
Organization Name:PONTUS HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:626-791-7595
Mailing Address - Street 1:1203 N AVALON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2646
Mailing Address - Country:US
Mailing Address - Phone:310-549-1000
Mailing Address - Fax:310-549-7000
Practice Address - Street 1:1203 N AVALON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-2646
Practice Address - Country:US
Practice Address - Phone:310-549-1000
Practice Address - Fax:310-549-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty