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General NPI Number Information
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NPI Number | 1104217165
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Entity Type | Organization
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Legal Business Name | BROADWAY PHARMACY CORPORATION
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 7600 PACIFIC AVE
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City | LEMON GROVE
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State | CA
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Zip | 91945
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Country | US
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Telephone | 619-717-8990
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Fax | 619-717-8616
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Provider Business Mailing Address
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Address Line | 7600 PACIFIC AVE
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City | LEMON GROVE
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State | CA
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Zip | 91945
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Country | US
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Telephone | 619-717-8990
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Fax | 619-717-8616
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Authorized Official
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Title or Position | CEO/CFO/SEC/DIR
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Name | MR. VINCENT T NGUYEN
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Credential | PHARM.D
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Telephone | 619-600-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | RPH 53335
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License Number State | CA
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