Provider Demographics
NPI:1912362377
Name:DT PHARMACY CORPORATION
Entity Type:Organization
Organization Name:DT PHARMACY CORPORATION
Other - Org Name:PHILLIP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:PHUONGDUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:619-458-9660
Mailing Address - Street 1:5507 EL CAJON BLVD # E
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3624
Mailing Address - Country:US
Mailing Address - Phone:619-458-9660
Mailing Address - Fax:619-326-8829
Practice Address - Street 1:5507 EL CAJON BLVD # E
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3624
Practice Address - Country:US
Practice Address - Phone:619-458-9660
Practice Address - Fax:619-326-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA537783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157313OtherPK