MEDICARE: SAIGON HOUSTON 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	25364	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4543674	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1841357167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAIGON HOUSTON PHARMACY LLC

Provider Business Mailing Address
First Line	:	8388 W SAM HOUSTON PKWY S
Second Line	:	STE 186
City	:	HOUSTON
State	:	TX
Zip	:	77072-5079
Country	:	US
Telephone Number	:	281-564-5400
Fax Number	:	281-564-5404

Provider Business Practice Location Address
First Line	:	8388 W SAM HOUSTON PKWY S
Second Line	:	STE 186
City	:	HOUSTON
State	:	TX
Zip	:	77072-5079
Country	:	US
Telephone Number	:	281-564-5400
Fax Number	:	281-564-5404

Authorized Official
Title or Position	:	OWNER AND PIC
Name	:	KIMBERLY TRUONG
Credential	:
Telephone Number	:	832-451-7296

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/10/2011

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