Provider Demographics
NPI:1760757439
Name:HARBOR HEALTHY LIVING PHARMACY INC
Entity Type:Organization
Organization Name:HARBOR HEALTHY LIVING PHARMACY INC
Other - Org Name:HARBOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:THINH
Authorized Official - Middle Name:HUNG
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:714-531-9988
Mailing Address - Street 1:16040 HARBOR BLVD
Mailing Address - Street 2:STE K
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1327
Mailing Address - Country:US
Mailing Address - Phone:714-531-9988
Mailing Address - Fax:714-531-9987
Practice Address - Street 1:16040 HARBOR BLVD
Practice Address - Street 2:STE K
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1327
Practice Address - Country:US
Practice Address - Phone:714-531-9988
Practice Address - Fax:714-531-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50888333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 50888OtherCALIFORNIA STATE BOARD OF PHARMACY
CA1760757439Medicaid