Provider Demographics
NPI:1689082133
Name:LE & NGUYEN PACIFIC PHARMACY
Entity Type:Organization
Organization Name:LE & NGUYEN PACIFIC PHARMACY
Other - Org Name:PACIFIC COAST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,MGR,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-230-5106
Mailing Address - Street 1:10515 MCFADDEN AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-5301
Mailing Address - Country:US
Mailing Address - Phone:714-260-9094
Mailing Address - Fax:714-849-5764
Practice Address - Street 1:10515 MCFADDEN AVE STE 104
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-5301
Practice Address - Country:US
Practice Address - Phone:714-260-9094
Practice Address - Fax:714-849-5764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA536603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147474OtherPK
CA1689082133Medicaid
2147474OtherPK