Provider Demographics
NPI:1487167730
Name:MEDS ENVY INC
Entity type:Organization
Organization Name:MEDS ENVY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YONG SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-576-7987
Mailing Address - Street 1:1849 AVENIDA DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-1820
Mailing Address - Country:US
Mailing Address - Phone:714-576-7987
Mailing Address - Fax:951-943-1577
Practice Address - Street 1:12873 HARBOR BLVD STE M3
Practice Address - Street 2:SUITE M-3
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5848
Practice Address - Country:US
Practice Address - Phone:217-721-3435
Practice Address - Fax:951-943-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CA558323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2173133OtherPK