Provider Demographics
NPI:1346833746
Name:PHI PHNOM PHARMACY INC
Entity Type:Organization
Organization Name:PHI PHNOM PHARMACY INC
Other - Org Name:NEW PHNOM PICH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHI
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:240-938-0753
Mailing Address - Street 1:2100 E ANAHEIM ST STE A
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3419
Mailing Address - Country:US
Mailing Address - Phone:562-434-7559
Mailing Address - Fax:408-434-3849
Practice Address - Street 1:2100 E ANAHEIM ST STE A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3419
Practice Address - Country:US
Practice Address - Phone:562-434-7559
Practice Address - Fax:408-434-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649372053OtherNPI
CA1649372053Medicaid