Organization
MODERNHEALTH HOLDINGS INC
Active
Other names
Modern Health Pharmacy - SD
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON CHOU (DIRECTOR, BUSINESS OPERATIONS)
(626) 932-1721
Entity
Organization
Contact information
Practice address
13220 EVENING CREEK DR S, STE 110, SAN DIEGO, CA 92128-4103
(858) 668-3350
(858) 668-3352
Mailing address
110 E HUNTINGTON DR, MONROVIA, CA 91016-3415
(858) 668-3350
(858) 668-3352
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PHY51002
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508094558
—
CA
01
—
2121362
PK
—
Enumeration date
06/29/2009
Last updated
04/19/2017
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