Healthcare Provider Details

I. General information

NPI: 1881297471
Provider Name (Legal Business Name): AUDREY VU PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9741 BOLSA AVE STE 116
WESTMINSTER CA
92683-6683
US

IV. Provider business mailing address

9741 BOLSA AVE STE 116
WESTMINSTER CA
92683-6683
US

V. Phone/Fax

Practice location:
  • Phone: 714-531-1983
  • Fax: 714-531-1989
Mailing address:
  • Phone: 714-531-1983
  • Fax: 714-531-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: