Provider Demographics
NPI:1255322400
Name:VAN NUYS PHARMACY
Entity Type:Organization
Organization Name:VAN NUYS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HANH
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:818-988-6191
Mailing Address - Street 1:7400 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1972
Mailing Address - Country:US
Mailing Address - Phone:818-988-6191
Mailing Address - Fax:818-988-4311
Practice Address - Street 1:7400 VAN NUYS BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1972
Practice Address - Country:US
Practice Address - Phone:818-988-6191
Practice Address - Fax:818-988-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY46197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA461970Medicaid