MEDICARE: MY LINH PHARMACY

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	PHY35463	CA

General Provider Information

NPI Number	:	1689665481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY LINH PHARMACY

Provider Business Mailing Address
First Line	:	151 INTERNATIONAL BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-2233
Country	:	US
Telephone Number	:	510-893-7388
Fax Number	:	510-339-2691

Provider Business Practice Location Address
First Line	:	151 INTERNATIONAL BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-2233
Country	:	US
Telephone Number	:	510-893-7388
Fax Number	:	510-339-2691

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN D PHAM
Credential	:	RPH
Telephone Number	:	510-893-7388

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	08/22/2020

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