1366677684 NPI number — BTN PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366677684 NPI number — BTN PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BTN PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BTN PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366677684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 S LEMON AVE
Provider Second Line Business Mailing Address:
# 1053
Provider Business Mailing Address City Name:
WALNUT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91788-2685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-214-2562
Provider Business Mailing Address Fax Number:
626-332-2566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1433 N HOLLENBECK AVE
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
COVINA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91722-1558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-214-2562
Provider Business Practice Location Address Fax Number:
626-332-2566
Provider Enumeration Date:
05/17/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUI-TRAN
Authorized Official First Name:
BICH-HONG
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO / PRESIDENT
Authorized Official Telephone Number:
626-214-2562

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  49838 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2120304 . This is a "PK" identifier . This identifiers is of the category "OTHER".