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General NPI Number Information
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NPI Number | 1013469717
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Entity Type | Individual
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Provider Name | MISS NGUYEN BICH TA
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Gender | Female
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 1720 AVIATION BLVD
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City | REDONDO BEACH
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State | CA
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Zip | 90278-2810
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Country | US
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Telephone | 310-376-4460
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Fax |
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Provider Business Mailing Address
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Address Line | 18652 AMBROSE LN
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-7028
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Country | US
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Telephone | 714-559-8075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 75667
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License Number State | CA
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