Provider Demographics
NPI:1164421988
Name:SON D NGUYEN & DUNG N LE
Entity Type:Organization
Organization Name:SON D NGUYEN & DUNG N LE
Other - Org Name:VINA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SON
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:559-224-5210
Mailing Address - Street 1:2308 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-2239
Mailing Address - Country:US
Mailing Address - Phone:559-224-5210
Mailing Address - Fax:559-225-5902
Practice Address - Street 1:2308 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-2239
Practice Address - Country:US
Practice Address - Phone:559-224-5210
Practice Address - Fax:559-225-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY34957183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA349570Medicaid
CA1164421988OtherNPI
CAPHY34957OtherCALIFORNIA PHARMACY STATE
0541878OtherNCPDP
CA5552980001Medicare NSC
CA1164421988OtherNPI
CAPHA349570Medicaid