Provider Demographics
NPI:1699767061
Name:TIN PHAT PHARMACY INC
Entity type:Organization
Organization Name:TIN PHAT PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:TO-NGA
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:714-379-5072
Mailing Address - Street 1:9081 BOLSA AVE
Mailing Address - Street 2:# 108
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5509
Mailing Address - Country:US
Mailing Address - Phone:714-379-5072
Mailing Address - Fax:714-379-5074
Practice Address - Street 1:9081 BOLSA AVE
Practice Address - Street 2:# 108
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5509
Practice Address - Country:US
Practice Address - Phone:714-379-5072
Practice Address - Fax:714-379-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA389350Medicaid
CA05-32300OtherNCPDP PROVIDER
9467325Medicare PIN
CA05-32300OtherNCPDP PROVIDER