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General NPI Number Information
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NPI Number | 1902051774
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Entity Type | Organization
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Legal Business Name | LINDA VISTA PHARMACY
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 11/20/2008
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Provider Practice Location Address
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Address Line | 520 W 17TH ST STE 7
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City | SANTA ANA
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State | CA
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Zip | 92706-3614
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Country | US
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Telephone | 714-542-8865
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Fax |
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Provider Business Mailing Address
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Address Line | 520 W 17TH ST STE 7
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City | SANTA ANA
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State | CA
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Zip | 92706-3614
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Country | US
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Telephone | 714-542-8865
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MS. LETU THI PHO
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Credential | RPH
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Telephone | 714-542-8865
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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 | PHY 43967
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License Number State | CA
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