Provider Demographics
NPI:1396204095
Name:NORDAHL PHARMACY CORP
Entity Type:Organization
Organization Name:NORDAHL PHARMACY CORP
Other - Org Name:NORDAHL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-501-0030
Mailing Address - Street 1:740 NORDAHL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3545
Mailing Address - Country:US
Mailing Address - Phone:760-501-0030
Mailing Address - Fax:760-501-0440
Practice Address - Street 1:740 NORDAHL RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3545
Practice Address - Country:US
Practice Address - Phone:760-501-0030
Practice Address - Fax:760-501-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy