Healthcare Provider Details

I. General information

NPI: 1386191237
Provider Name (Legal Business Name): PETER VU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 05/28/2026
Certification Date:
Deactivation Date: 08/06/2024
Reactivation Date: 05/28/2026

III. Provider practice location address

15232 SHERMAN WAY
VAN NUYS CA
91405-2022
US

IV. Provider business mailing address

15232 SHERMAN WAY
VAN NUYS CA
91405-2022
US

V. Phone/Fax

Practice location:
  • Phone: 818-374-3480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: