Healthcare Provider Details

I. General information

NPI: 1376489773
Provider Name (Legal Business Name): MERCY HEALTH PHARMACY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9483 CAMINO RUIZ STE C
SAN DIEGO CA
92126-4472
US

IV. Provider business mailing address

9483 CAMINO RUIZ STE C
SAN DIEGO CA
92126-4472
US

V. Phone/Fax

Practice location:
  • Phone: 858-253-8337
  • Fax: 858-253-8424
Mailing address:
  • Phone: 858-253-8337
  • Fax: 858-253-8424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIEN THAI BACH
Title or Position: PRESIDENT
Credential:
Phone: 858-253-8337