Healthcare Provider Details

I. General information

NPI: 1073280491
Provider Name (Legal Business Name): TIMMY NGUYEN LUU I PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 H ST
CHULA VISTA CA
91910-4328
US

IV. Provider business mailing address

4070 WINONA AVE
SAN DIEGO CA
92105-2115
US

V. Phone/Fax

Practice location:
  • Phone: 619-420-7120
  • Fax: 619-420-1602
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: