Healthcare Provider Details

I. General information

NPI: 1588758031
Provider Name (Legal Business Name): VAN RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14441 BROOKHURST ST STE 4
GARDEN GROVE CA
92843-4646
US

IV. Provider business mailing address

14441 BROOKHURST ST STE 4
GARDEN GROVE CA
92843-4646
US

V. Phone/Fax

Practice location:
  • Phone: 714-775-1789
  • Fax: 714-775-0470
Mailing address:
  • Phone: 714-775-1789
  • Fax: 714-775-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY39430
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA NGOC NGUYEN
Title or Position: CEO/PIC
Credential: PHARM.D.
Phone: 714-775-1789