Provider Demographics
NPI:1649372053
Name:PHI PHNOM PHARMACY INC
Entity type:Organization
Organization Name:PHI PHNOM PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHI
Authorized Official - Middle Name:TIEN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:562-434-7559
Mailing Address - Street 1:2100 E ANAHEIM ST
Mailing Address - Street 2:STE A
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 E ANAHEIM ST
Practice Address - Street 2:STE A
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3408
Practice Address - Country:US
Practice Address - Phone:562-434-7559
Practice Address - Fax:562-434-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA407540Medicaid
0526802OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0526802OtherOTHER ID NUMBER