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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	53778	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2157313	OTHER		PK

General Provider Information

NPI Number	:	1912362377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DT PHARMACY CORPORATION

Provider Business Mailing Address
First Line	:	5507 EL CAJON BLVD # E
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3624
Country	:	US
Telephone Number	:	619-458-9660
Fax Number	:	619-326-8829

Provider Business Practice Location Address
First Line	:	5507 EL CAJON BLVD # E
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3624
Country	:	US
Telephone Number	:	619-458-9660
Fax Number	:	619-326-8829

Authorized Official
Title or Position	:	PRES, PIC, AO
Name	:	PHUONGDUNG NGUYEN
Credential	:	RPH
Telephone Number	:	619-458-9660

Provider Enumeration Date	:	12/29/2015
Last Update Date	:	01/20/2016

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Directions to “DT PHARMACY CORPORATION ” Practice Location

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