Provider Demographics
NPI:1538223953
Name:FIRST PHARMACY
Entity type:Organization
Organization Name:FIRST PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:T
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-896-9518
Mailing Address - Street 1:9262 BOLSA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-8905
Mailing Address - Country:US
Mailing Address - Phone:714-896-9518
Mailing Address - Fax:714-896-9618
Practice Address - Street 1:9262 BOLSA AVE STE A
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-8905
Practice Address - Country:US
Practice Address - Phone:714-896-9518
Practice Address - Fax:714-896-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH43879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA421520Medicaid
CAPHA421520Medicaid