Healthcare Provider Details

I. General information

NPI: 1134887359
Provider Name (Legal Business Name): GOLD STALLION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2021
Last Update Date: 12/28/2023
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2895 TEMPLE AVE.
SIGNAL HILL CA
90755
US

IV. Provider business mailing address

2895 TEMPLE AVE.
SIGNAL HILL CA
90755
US

V. Phone/Fax

Practice location:
  • Phone: 888-881-9924
  • Fax:
Mailing address:
  • Phone: 888-881-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. HENRY TRUONG
Title or Position: CEO/CFO/DIR.
Credential: PHARMD
Phone: 888-881-9924