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General NPI Number Information
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NPI Number | 1104999119
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Entity Type | Organization
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Legal Business Name | PACIFIC PHARMACY
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 2874 ALUM ROCK AVE STE A
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City | SAN JOSE
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State | CA
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Zip | 95127-2804
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Country | US
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Telephone | 408-937-4618
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Fax | 408-937-8371
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Provider Business Mailing Address
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Address Line | 2874 ALUM ROCK AVE STE A
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City | SAN JOSE
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State | CA
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Zip | 95127-2804
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Country | US
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Telephone | 408-937-4618
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Fax | 408-937-8371
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Authorized Official
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Title or Position | OWNER
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Name | MR. HUNG VIET NGUYEN
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Credential |
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Telephone | 408-937-4618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 47826
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 47826
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License Number State | CA
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