MEDICARE: ULTUM CARE PHARMACY, LLC.

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1801674155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTUM CARE PHARMACY, LLC.

Provider Business Mailing Address
First Line	:	9701 GARDEN GROVE BLVD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1614
Country	:	US
Telephone Number	:	657-212-9898
Fax Number	:	657-202-2588

Provider Business Practice Location Address
First Line	:	9701 GARDEN GROVE BLVD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1614
Country	:	US
Telephone Number	:	714-981-7467
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	QUANG VU
Credential	:	PHARMACIST
Telephone Number	:	714-467-7687

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	03/19/2025

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