Provider Demographics
NPI:1124228549
Name:LINDA RX PHARMACY INC
Entity Type:Organization
Organization Name:LINDA RX PHARMACY INC
Other - Org Name:LINDA RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHUONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:408-270-2828
Mailing Address - Street 1:1569 LEXANN AVE
Mailing Address - Street 2:130
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1794
Mailing Address - Country:US
Mailing Address - Phone:408-270-2828
Mailing Address - Fax:408-270-2092
Practice Address - Street 1:1569 LEXANN AVE
Practice Address - Street 2:130
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1794
Practice Address - Country:US
Practice Address - Phone:408-270-2828
Practice Address - Fax:408-270-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY486453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5628372OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA486450Medicaid
5628372OtherNCPDP PROVIDER IDENTIFICATION NUMBER