Organization
BOLSA MEDICAL MTM PHARMA INC
Active
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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