Healthcare Provider Details

I. General information

NPI: 1275987885
Provider Name (Legal Business Name): GOOD HEART PHARMACISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 FRUITRIDGE RD # 104
SACRAMENTO CA
95822-3067
US

IV. Provider business mailing address

1740 FRUITRIDGE RD # 104
SACRAMENTO CA
95822-3067
US

V. Phone/Fax

Practice location:
  • Phone: 916-238-3118
  • Fax: 916-238-3119
Mailing address:
  • Phone: 916-238-3118
  • Fax: 916-238-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number54250
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PHUONG VU
Title or Position: PHARMACIST
Credential:
Phone: 209-747-0614