Healthcare Provider Details

I. General information

NPI: 1013212323
Provider Name (Legal Business Name): CUONG TRINH PHARM D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14777 LOS GATOS BLVD STE 101
LOS GATOS CA
95032-2059
US

IV. Provider business mailing address

14777 LOS GATOS BLVD STE 101
LOS GATOS CA
95032-2059
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-4848
  • Fax: 408-356-4949
Mailing address:
  • Phone: 408-356-4848
  • Fax: 408-356-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50586
License Number StateCA

VIII. Authorized Official

Name: TRINH CUONG
Title or Position: PRESIDENT
Credential:
Phone: 408-356-4848