Healthcare Provider Details

I. General information

NPI: 1609201664
Provider Name (Legal Business Name): BOLSA EXPRESS PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9262 BOLSA AVE SUITE A
WESTMINSTER CA
92683-8905
US

IV. Provider business mailing address

9262 BOLSA AVE STE A
WESTMINSTER CA
92683-8905
US

V. Phone/Fax

Practice location:
  • Phone: 714-891-8810
  • Fax: 714-891-8805
Mailing address:
  • Phone: 714-891-8810
  • Fax: 714-891-8805

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: MS. UYEN NGOC TRAN
Title or Position: PRESIDENT/PIC
Credential: R.PH
Phone: 714-891-8810