Provider Demographics
NPI:1235676669
Name:SAIGON EXPRESS PHARMACY INC
Entity Type:Organization
Organization Name:SAIGON EXPRESS PHARMACY INC
Other - Org Name:CONCORD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:QUYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-345-5205
Mailing Address - Street 1:102 PARRISH LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3456
Mailing Address - Country:US
Mailing Address - Phone:302-345-5205
Mailing Address - Fax:
Practice Address - Street 1:3613 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-5101
Practice Address - Country:US
Practice Address - Phone:302-478-1212
Practice Address - Fax:302-478-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
DEA3-00010083336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250020460Medicaid
2167347OtherPK