MEDICARE: MODERN DRUG INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	53920	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2158307	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447610191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN DRUG INC

Provider Business Mailing Address
First Line	:	10672 CHAPMAN AVE STE 5
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-3103
Country	:	US
Telephone Number	:	714-867-6502
Fax Number	:	714-867-6487

Provider Business Practice Location Address
First Line	:	10672 CHAPMAN AVE STE 5
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-3103
Country	:	US
Telephone Number	:	714-867-6502
Fax Number	:	714-867-6487

Authorized Official
Title or Position	:	PIC
Name	:	QUOC LUONG
Credential	:
Telephone Number	:	714-867-6502

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	10/24/2016

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Directions to “MODERN DRUG INC ” Practice Location

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