Organization
BOLSA MEDICAL MTM PHARMA INC
Active
Other names
MTM PHARMACY IV
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TINA TUYET QUACH-TRAN (PRESIDENT / PHARMACIST IN CHARGE)
(714) 916-5383
Entity
Organization
Contact information
Practice address
6552 BOLSA AVE STE A, HUNTINGTON BEACH, CA 92647-2656
(714) 916-5383
(714) 916-5384
Mailing address
6552 BOLSA AVE, STE A, HUNTINGTON BEACH, CA 92647-2660
(714) 916-5383
(714) 916-5384
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3622641
—
CA
01
—
PHY57954
BOARD OF PHARMACY
CA
Enumeration date
05/03/2017
Last updated
04/13/2022
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