Provider Demographics
NPI:1588758031
Name:VAN RX INC
Entity type:Organization
Organization Name:VAN RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PIC
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-775-1789
Mailing Address - Street 1:14441 BROOKHURST ST STE 4
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4646
Mailing Address - Country:US
Mailing Address - Phone:714-775-1789
Mailing Address - Fax:714-775-0470
Practice Address - Street 1:14441 BROOKHURST ST STE 4
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4646
Practice Address - Country:US
Practice Address - Phone:714-775-1789
Practice Address - Fax:714-775-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336M0003X, 332B00000X, 333600000X, 3336C0003X
CAPHY394303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA394300Medicaid
0543771OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1191860001Medicare NSC