Provider Demographics
NPI:1629947437
Name:BROADWAY PHARMACY
Entity type:Organization
Organization Name:BROADWAY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT TAI
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-360-2152
Mailing Address - Street 1:2530 S BROADWAY STE F
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7880
Mailing Address - Country:US
Mailing Address - Phone:714-360-2152
Mailing Address - Fax:
Practice Address - Street 1:2530 S BROADWAY STE F
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7880
Practice Address - Country:US
Practice Address - Phone:714-360-2152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy