Provider Demographics
NPI:1952532194
Name:REGIONAL PHARMACY INC.
Entity Type:Organization
Organization Name:REGIONAL PHARMACY INC.
Other - Org Name:SAN JOSE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE/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:468-254-8884
Mailing Address - Street 1:200 JOSE FIGUERES AVE STE 235
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1599
Mailing Address - Country:US
Mailing Address - Phone:408-254-8884
Mailing Address - Fax:408-254-8885
Practice Address - Street 1:200 JOSE FIGUERES AVE STE 235
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1599
Practice Address - Country:US
Practice Address - Phone:408-254-8884
Practice Address - Fax:408-254-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY498783336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121501OtherPK