1669698742 NPI number — AUDREY 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 1669698742 NPI number — AUDREY PHARMACY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUDREY 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:
Provider Other Organization Name Type Code:
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:
1669698742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12641 WYNANT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92841-4440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-531-1983
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9741 BOLSA AVE
Provider Second Line Business Practice Location Address:
STE# 116
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92683-6601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-531-1983
Provider Business Practice Location Address Fax Number:
714-531-1989
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VU
Authorized Official First Name:
AUDREY
Authorized Official Middle Name:
NGOCDAO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-531-1983

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  48557 , 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)





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