Provider Demographics
NPI:1720497613
Name:VU, JOHNATHAN H (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:H
Last Name:VU
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 N MILLIKEN AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764
Mailing Address - Country:US
Mailing Address - Phone:909-476-9083
Mailing Address - Fax:909-476-9044
Practice Address - Street 1:951 N MILLIKEN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764
Practice Address - Country:US
Practice Address - Phone:909-476-9083
Practice Address - Fax:909-476-9044
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist