Organization
LUCKY PHARMACY INC
Active
Other names
LUCKY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SHIUFONG YAN (PRESIDENT)
(626) 282-2277
Entity
Organization
Contact information
Practice address
416 W LAS TUNAS DR, STE 100, SAN GABRIEL, CA 91776-1236
(626) 282-2277
(626) 458-8329
Mailing address
416 W LAS TUNAS DR, STE 100, SAN GABRIEL, CA 91776-1236
(626) 282-2277
(626) 458-8329
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY48786
CA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0519097
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/09/2005
Last updated
04/10/2021
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