Provider Demographics
NPI:1437502523
Name:VIET TOWN PHARMACY
Entity Type:Organization
Organization Name:VIET TOWN PHARMACY
Other - Org Name:VIET TOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KHOA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:408-728-2407
Mailing Address - Street 1:5669 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2229
Mailing Address - Country:US
Mailing Address - Phone:408-728-2407
Mailing Address - Fax:
Practice Address - Street 1:999 STORY RD UNIT 9024
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-4604
Practice Address - Country:US
Practice Address - Phone:408-728-2407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY54955333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164672OtherPK