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General NPI Number Information
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NPI Number | 1700036290
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Entity Type | Organization
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Legal Business Name | VAN LOU INVESTMENTS
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 31571 CANYON ESTATES DR. #118
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City | LAKE ELSINORE
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State | CA
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Zip | 92530
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Country | US
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Telephone | 714-642-1514
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Fax | 714-993-3320
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Provider Business Mailing Address
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Address Line | 31571 CANYON ESTATES DR. # 118
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City | LAKE ELSINORE
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State | CA
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Zip | 92532
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Country | US
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Telephone | 951-245-4488
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Fax | 951-245-4466
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Authorized Official
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Title or Position | OWNER
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Name | LOUIS X NGUYEN
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Credential |
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Telephone | 951-245-4488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 49127
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License Number State | CA
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