Provider Demographics
NPI:1962870634
Name:PARAGON COMPOUNDING PHARMACY, INC
Entity type:Organization
Organization Name:PARAGON COMPOUNDING PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPHHUNG
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:714-388-6488
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92815-0937
Mailing Address - Country:US
Mailing Address - Phone:714-707-5099
Mailing Address - Fax:714-707-4051
Practice Address - Street 1:1585 WEST BROADWAY SUITE A
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802
Practice Address - Country:US
Practice Address - Phone:714-707-5099
Practice Address - Fax:714-707-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55967OtherPHARMACY LICENSE
CA53477OtherPHARMACY LICENSE