Organization
FORMOSA HEALTH CORP
Active
Other names
BASE LINE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX TSENG (PRESIDENT)
(909) 463-4631
Entity
Organization
Contact information
Practice address
13451 BASELINE AVE, STE C, FONTANA, CA 92336-5472
(909) 463-4631
(909) 463-0945
Mailing address
13451 BASELINE AVE, STE C, FONTANA, CA 92336-5472
(909) 463-4631
(909) 463-0945
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY45877
CA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2004919
PK
—
05
—
PHA458770
—
CA
Enumeration date
08/10/2006
Last updated
07/02/2014
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