MEDICARE: MISS NGUYEN BICH TA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	75667	CA

General Provider Information

NPI Number	:	1013469717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NGUYEN BICH TA

Provider Business Mailing Address
First Line	:	18652 AMBROSE LN
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-7028
Country	:	US
Telephone Number	:	714-559-8075
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 AVIATION BLVD
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-2810
Country	:	US
Telephone Number	:	310-376-4460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2016
Last Update Date	:	10/28/2016

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