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General NPI Number Information
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NPI Number | 1306372891
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Entity Type | Organization
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Legal Business Name | BOLSA MEDICAL MTM PHARMA INC
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 6552 BOLSA AVE STE A
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-2656
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Country | US
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Telephone | 714-916-5383
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Fax | 714-916-5384
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Provider Business Mailing Address
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Address Line | 6552 BOLSA AVE STE A
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-2660
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Country | US
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Telephone | 714-916-5383
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Fax | 714-916-5384
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Authorized Official
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Title or Position | PRESIDENT / PHARMACIST IN CHARGE
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Name | MS. TINA TUYET QUACH-TRAN
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Credential |
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Telephone | 714-916-5383
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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