Organization
HAN SAM CORP
Active
Other names
River's Edge Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
HANY BENJAMIN (CEO)
(760) 340-3248
Entity
Organization
Contact information
Practice address
36919 COOK ST STE 102, PALM DESERT, CA 92211-6069
(760) 340-3248
(760) 340-3258
Mailing address
36919 COOK ST, SUITE 102, PALM DESERT, CA 92211-6069
(760) 340-3248
(760) 340-3258
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PHY49157
CA
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689823486
—
CA
01
—
2117821
PK
—
Enumeration date
09/17/2008
Last updated
12/21/2017
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