Basic Information
| Provider Information | |||||||||
| NPI: | 1770817603 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAIGON PHARMACY | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 210 N JACKSON AVE STE 10 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951161621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082183696 | ||||||||
| FaxNumber: | 4085169849 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 N JACKSON AVE STE 10 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951161621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082183696 | ||||||||
| FaxNumber: | 4085169849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2009 | ||||||||
| LastUpdateDate: | 09/24/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TON-NU | ||||||||
| AuthorizedOfficialFirstName: | HOAI-AN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4082183696 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | REGISTERED PHARMACIS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PHY 38176 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | PHA 381760 | 01 | CA | MEDICARE PROVIDER | OTHER |