Provider Demographics
NPI:1588757918
Name:BOI BUI TRINH & TU DUC PHAM PTR
Entity type:Organization
Organization Name:BOI BUI TRINH & TU DUC PHAM PTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOI
Authorized Official - Middle Name:BUI
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-775-0772
Mailing Address - Street 1:10362 BOLSA AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6763
Mailing Address - Country:US
Mailing Address - Phone:714-775-0772
Mailing Address - Fax:714-775-8747
Practice Address - Street 1:10362 BOLSA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6763
Practice Address - Country:US
Practice Address - Phone:714-775-0772
Practice Address - Fax:714-775-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY399413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0549521OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA399410Medicaid
1114970001Medicare NSC