MEDICARE: PNS PHARMA INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY51222	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2139315	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902895766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PNS PHARMA INC

Provider Business Mailing Address
First Line	:	14384 BROOKHURST ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-4608
Country	:	US
Telephone Number	:	714-531-1740
Fax Number	:	714-531-9624

Provider Business Practice Location Address
First Line	:	14384 BROOKHURST ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-4608
Country	:	US
Telephone Number	:	714-531-1740
Fax Number	:	714-531-9624

Authorized Official
Title or Position	:	RPH
Name	:	NGOC VU
Credential	:
Telephone Number	:	714-531-1740

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	12/21/2015

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Directions to “PNS PHARMA INC ” Practice Location

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