Provider Demographics
NPI:1770817603
Name:SAIGON PHARMACY
Entity Type:Organization
Organization Name:SAIGON PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOAI-AN
Authorized Official - Middle Name:
Authorized Official - Last Name:TON-NU
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED PHARMACIS
Authorized Official - Phone:408-218-3696
Mailing Address - Street 1:210 N JACKSON AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1621
Mailing Address - Country:US
Mailing Address - Phone:408-218-3696
Mailing Address - Fax:408-516-9849
Practice Address - Street 1:210 N JACKSON AVE STE 10
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1621
Practice Address - Country:US
Practice Address - Phone:408-218-3696
Practice Address - Fax:408-516-9849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 38176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA 381760OtherMEDICARE PROVIDER