Healthcare Provider Details

I. General information

NPI: 1457813131
Provider Name (Legal Business Name): JADE 2 PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10133 S DE ANZA BLVD STE B
CUPERTINO CA
95014-2126
US

IV. Provider business mailing address

10133 S DE ANZA BLVD STE B
CUPERTINO CA
95014-2126
US

V. Phone/Fax

Practice location:
  • Phone: 408-899-4199
  • Fax: 408-816-7265
Mailing address:
  • Phone: 408-899-4199
  • Fax: 408-816-7265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: AN DUY NGUYEN
Title or Position: PRESIDENT
Credential:
Phone: 559-765-1325