Provider Demographics
NPI:1699817247
Name:DONG LAN CORPORATION
Entity Type:Organization
Organization Name:DONG LAN CORPORATION
Other - Org Name:SAIGON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIET
Authorized Official - Middle Name:THE
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:617-282-9134
Mailing Address - Street 1:1167 A DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125
Mailing Address - Country:US
Mailing Address - Phone:617-282-9134
Mailing Address - Fax:617-282-9317
Practice Address - Street 1:1167 A DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125
Practice Address - Country:US
Practice Address - Phone:617-282-9134
Practice Address - Fax:617-282-9317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0445738Medicaid
MA2236570Medicare ID - Type Unspecified