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NPI Code Detail

MEDICARE: NUKUCHA VANG RPH

MEDICARE: NUKUCHA VANG RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist83720CA

General Provider Information

NPI Number : 1356936140
Entity Type Code : Individual
Provider Name (Legal Business Name) : NUKUCHA VANG RPH
Provider Business Mailing Address
First Line : 3000 HARBISON DR
Second Line :
City : VACAVILLE
State : CA
Zip : 95687-3909
Country : US
Telephone Number : 707-452-8119
Fax Number :
Provider Business Practice Location Address
First Line : 9285 ELK GROVE BLVD
Second Line :
City : ELK GROVE
State : CA
Zip : 95624-2101
Country : US
Telephone Number : 916-714-5372
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2021
Last Update Date : 04/12/2023

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