Provider Demographics
NPI:1326328519
Name:LA, VINH THE (RPH)
Entity Type:Individual
Prefix:
First Name:VINH
Middle Name:THE
Last Name:LA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 SARATOGA AVE APT Z303
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2439
Mailing Address - Country:US
Mailing Address - Phone:408-568-8530
Mailing Address - Fax:
Practice Address - Street 1:2111 MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-5219
Practice Address - Country:US
Practice Address - Phone:831-420-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist