Provider Demographics
NPI:1841784154
Name:BELLA TERRA PHARMACY INC
Entity Type:Organization
Organization Name:BELLA TERRA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAMANH
Authorized Official - Middle Name:N
Authorized Official - Last Name:TON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-675-0453
Mailing Address - Street 1:16121 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3804
Mailing Address - Country:US
Mailing Address - Phone:949-220-2554
Mailing Address - Fax:949-438-6044
Practice Address - Street 1:16121 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3804
Practice Address - Country:US
Practice Address - Phone:949-220-2554
Practice Address - Fax:949-438-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA297116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty