Healthcare Provider Details

I. General information

NPI: 1437502523
Provider Name (Legal Business Name): VIET TOWN PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 STORY RD UNIT 9024
SAN JOSE CA
95122-4604
US

IV. Provider business mailing address

5669 MORNINGSIDE DR
SAN JOSE CA
95138-2229
US

V. Phone/Fax

Practice location:
  • Phone: 408-728-2407
  • Fax:
Mailing address:
  • Phone: 408-728-2407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY54955
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KHOA PHAM
Title or Position: PRESIDENT/TREASURER
Credential: RPH
Phone: 408-728-2407