Provider Demographics
NPI:1437219664
Name:EXCELLENT HEALTH INC
Entity type:Organization
Organization Name:EXCELLENT HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:909-569-2005
Mailing Address - Street 1:223 N GARFIELD AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1700
Mailing Address - Country:US
Mailing Address - Phone:626-571-0154
Mailing Address - Fax:626-571-1192
Practice Address - Street 1:223 N GARFIELD AVE
Practice Address - Street 2:STE 101
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1700
Practice Address - Country:US
Practice Address - Phone:626-571-0154
Practice Address - Fax:626-571-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY448323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1998446OtherPK
CA1437219664Medicaid