Provider Demographics
NPI:1982919478
Name:HARBOR HEALTHY LIVING PHARMACY INC
Entity Type:Organization
Organization Name:HARBOR HEALTHY LIVING PHARMACY INC
Other - Org Name:HARBOR HEALTHY LIVING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:THINH
Authorized Official - Middle Name:HUNG
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:714-531-8080
Mailing Address - Street 1:646 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-1384
Mailing Address - Country:US
Mailing Address - Phone:714-531-8080
Mailing Address - Fax:714-531-9090
Practice Address - Street 1:646 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-1384
Practice Address - Country:US
Practice Address - Phone:714-531-8080
Practice Address - Fax:714-531-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 50369333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56-38688OtherNCPDP PROVIDER NUMBER
CAPHY 50369OtherRETAIL PHARMACY PERMIT
CA6682190001Medicare NSC