=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417012840
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIETNAM PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2006
-----------------------------------------------------
Last Update Date | 11/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2621 MILAM ST STE C SUITE C
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77006-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-520-0205
-----------------------------------------------------
Fax | 713-520-9714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2621 MILAM STREET SUITE C
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77006-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-520-0205
-----------------------------------------------------
Fax | 713-520-9714
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC
-----------------------------------------------------
Name | THUY LE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-520-0205
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 15886
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------