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General NPI Number Information
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NPI Number | 1790783025
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Entity Type | Organization
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Legal Business Name | DT PHARMACY CORPORATION
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 4616 EL CAJON BLVD STE 6
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City | SAN DIEGO
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State | CA
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Zip | 92115-4490
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Country | US
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Telephone | 619-563-8212
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Fax | 619-563-8211
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Provider Business Mailing Address
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Address Line | 4616 EL CAJON BLVD STE 6
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City | SAN DIEGO
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State | CA
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Zip | 92115-4490
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Country | US
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Telephone | 619-563-8212
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Fax | 619-563-8211
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | PHUONGDUNG NGUYEN
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Credential |
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Telephone | 714-331-4551
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY50623
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License Number State | CA
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