Provider Demographics
NPI:1477548816
Name:PHUC T NGUYEN
Entity Type:Organization
Organization Name:PHUC T NGUYEN
Other - Org Name:QUALITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHUC
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-449-0448
Mailing Address - Street 1:2605 W ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4209
Mailing Address - Country:US
Mailing Address - Phone:714-449-0448
Mailing Address - Fax:714-449-0987
Practice Address - Street 1:2605 W ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4209
Practice Address - Country:US
Practice Address - Phone:714-449-0448
Practice Address - Fax:714-449-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY44273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA442730Medicaid
CAPHA442730Medicaid