Healthcare Provider Details

I. General information

NPI: 1396204095
Provider Name (Legal Business Name): NORDAHL PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 NORDAHL RD STE 120
SAN MARCOS CA
92069-3545
US

IV. Provider business mailing address

740 NORDAHL RD STE 120
SAN MARCOS CA
92069-3545
US

V. Phone/Fax

Practice location:
  • Phone: 760-501-0030
  • Fax: 760-501-0440
Mailing address:
  • Phone: 760-501-0030
  • Fax: 760-501-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. TUAN Q. VU
Title or Position: PRESIDENT/PIC
Credential:
Phone: 760-501-0030