Healthcare Provider Details

I. General information

NPI: 1982919478
Provider Name (Legal Business Name): HARBOR HEALTHY LIVING PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 S HARBOR BLVD
SANTA ANA CA
92704-1384
US

IV. Provider business mailing address

646 S HARBOR BLVD
SANTA ANA CA
92704-1384
US

V. Phone/Fax

Practice location:
  • Phone: 714-531-8080
  • Fax: 714-531-9090
Mailing address:
  • Phone: 714-531-8080
  • Fax: 714-531-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY 50369
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 50369
License Number StateCA

VIII. Authorized Official

Name: MR. THINH HUNG TRAN
Title or Position: PRESIDENT/ PIC
Credential: PHARM D
Phone: 714-531-8080