Provider Demographics
NPI:1841625407
Name:TRUCARE PHARMACY LLC
Entity type:Organization
Organization Name:TRUCARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:VUONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-583-9550
Mailing Address - Street 1:12918 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5809
Mailing Address - Country:US
Mailing Address - Phone:714-583-9550
Mailing Address - Fax:714-795-3949
Practice Address - Street 1:12918 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5809
Practice Address - Country:US
Practice Address - Phone:714-583-9550
Practice Address - Fax:714-795-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0635640Medicaid
CA7079390001Medicare NSC