Provider Demographics
NPI:1013212323
Name:CUONG TRINH PHARM D INC
Entity Type:Organization
Organization Name:CUONG TRINH PHARM D INC
Other - Org Name:WELLNESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRINH
Authorized Official - Middle Name:
Authorized Official - Last Name:CUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-356-4848
Mailing Address - Street 1:14777 LOS GATOS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2059
Mailing Address - Country:US
Mailing Address - Phone:408-356-4848
Mailing Address - Fax:408-356-4949
Practice Address - Street 1:14777 LOS GATOS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2059
Practice Address - Country:US
Practice Address - Phone:408-356-4848
Practice Address - Fax:408-356-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5640215OtherNCPDP PROVIDER IDENTIFICATION NUMBER