Provider Demographics
NPI:1699796656
Name:NOGALES PHARMACY INC
Entity type:Organization
Organization Name:NOGALES PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAR LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:BS MS PHD
Authorized Official - Phone:626-810-2240
Mailing Address - Street 1:18702 COLIMA RD
Mailing Address - Street 2:STE 103
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2990
Mailing Address - Country:US
Mailing Address - Phone:626-810-2240
Mailing Address - Fax:626-810-2193
Practice Address - Street 1:18702 COLIMA RD
Practice Address - Street 2:STE 103
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2990
Practice Address - Country:US
Practice Address - Phone:626-810-2240
Practice Address - Fax:626-810-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY354863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA354860Medicaid
2000224OtherPK
2000224OtherPK