Provider Demographics
NPI:1609201664
Name:BOLSA EXPRESS PHARMACY, INC.
Entity Type:Organization
Organization Name:BOLSA EXPRESS PHARMACY, INC.
Other - Org Name:BOLSA EXPRESS PHARMACY,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MS
Authorized Official - First Name:UYEN
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-891-8810
Mailing Address - Street 1:9262 BOLSA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-8905
Mailing Address - Country:US
Mailing Address - Phone:714-891-8810
Mailing Address - Fax:714-891-8805
Practice Address - Street 1:9262 BOLSA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-8905
Practice Address - Country:US
Practice Address - Phone:714-891-8810
Practice Address - Fax:714-891-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7046950001Medicare NSC