Healthcare Provider Details

I. General information

NPI: 1871960450
Provider Name (Legal Business Name): AVENTYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CARLSBAD VILLAGE DR STE 108A
CARLSBAD CA
92008-2990
US

IV. Provider business mailing address

1490 TARA CT
CARLSBAD CA
92008-2647
US

V. Phone/Fax

Practice location:
  • Phone: 231-794-2328
  • Fax:
Mailing address:
  • Phone: 231-794-2328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73241
License Number StateCA

VIII. Authorized Official

Name: DR. NICHOLAS THINH TRUONG VU
Title or Position: PHARMACIST
Credential: PHARM.D.
Phone: 651-226-0931