Organization
BROADWAY MEDICAL PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VAN PHI LE RPH41632 (DIRECT OWNER)
(714) 772-3630
Entity
Organization
Contact information
Practice address
1673 W BROADWAY STE 1, ANAHEIM, CA 92802-1109
(714) 772-3630
(714) 772-3631
Mailing address
1673 W. BROADWAY SUIT #1, ANAHEIM, CA 92802
(714) 772-3630
(714) 772-3631
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PHY40768
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA407680
—
CA
Enumeration date
02/08/2007
Last updated
08/22/2020
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