Formosa Health Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY45877 Issued in CA

Legal business name

FORMOSA HEALTH CORP

Doing business as

Base Line Pharmacy

Practice address

13451 Baseline Ave
Ste C
Fontana, CA 92336-5472

Phone

(909) 463-4631

Fax

(909) 463-0945

NPI assigned

Aug 10, 2006

Last updated

Jul 2, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alex Tseng

Title

President

Phone

(909) 463-4631

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• BASE LINE PHARMACY Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lih Gen (Tracy) Lee

  • Pharmacist
  • Fontana, CA
  • NPI 1245641687
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404259200000",
    "number": "1639180128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13451 BASELINE AVE",
            "address_2": "STE C",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923365472",
            "telephone_number": "909-463-4631",
            "fax_number": "909-463-0945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13451 BASELINE AVE",
            "address_2": "STE C",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923365472",
            "telephone_number": "909-463-4631",
            "fax_number": "909-463-0945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORMOSA HEALTH CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2014-07-02",
        "status": "A",
        "authorized_official_last_name": "TSENG",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-463-4631"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY45877",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2004919",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA458770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BASE LINE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fontana Unified School District
• Fontana Unified School District
• Fontana Unified School District
• Foothill Family Medical Clinic Inc
• Foothill Serenity Living LLC (Foothill Serenity Living)
• Amy Foster, PHARM D
• Jevonne Foster
• Kathryn Mary Foster, OTR
• Marilou Fraire, RD
• Paul Fraire, RD

• Community/Retail Pharmacy in Fontana, CA
• Providers in Fontana, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.