Provider Demographics
NPI:1114717667
Name:HACIENDA CENTER PHARMACY
Entity type:Organization
Organization Name:HACIENDA CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUANZI
Authorized Official - Middle Name:
Authorized Official - Last Name:FENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-900-8862
Mailing Address - Street 1:1607 1/4 S AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-3830
Mailing Address - Country:US
Mailing Address - Phone:626-900-8862
Mailing Address - Fax:626-414-2372
Practice Address - Street 1:1607 1/4 S AZUSA AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-3830
Practice Address - Country:US
Practice Address - Phone:626-900-8862
Practice Address - Fax:626-414-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy