MEDICARE: DT PHARMACY CORPORATION

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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	PHY50623	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2130131	OTHER		PK

General Provider Information

NPI Number	:	1790783025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DT PHARMACY CORPORATION

Provider Business Mailing Address
First Line	:	4616 EL CAJON BLVD
Second Line	:	STE 6
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4490
Country	:	US
Telephone Number	:	619-563-8212
Fax Number	:	619-563-8211

Provider Business Practice Location Address
First Line	:	4616 EL CAJON BLVD
Second Line	:	STE 6
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4490
Country	:	US
Telephone Number	:	619-563-8212
Fax Number	:	619-563-8211

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	PHUONGDUNG NGUYEN
Credential	:
Telephone Number	:	714-331-4551

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/08/2015

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Directions to “DT PHARMACY CORPORATION ” Practice Location

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