Provider Demographics
NPI:1396836011
Name:GOLDEN PHARMACY CORPORATION
Entity Type:Organization
Organization Name:GOLDEN PHARMACY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-839-0256
Mailing Address - Street 1:10301 BOLSA AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6784
Mailing Address - Country:US
Mailing Address - Phone:714-839-0256
Mailing Address - Fax:714-839-1704
Practice Address - Street 1:10301 BOLSA AVE STE 105
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6784
Practice Address - Country:US
Practice Address - Phone:714-839-0256
Practice Address - Fax:714-839-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY380863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY38086OtherSTATE LICENCE
CAPHA380860Medicaid
CA1217240001Medicare NSC