Organization
LIEN THI KHONG
Active
Other names
MANNA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUSIE PHAN (PHARMACIST-IN-CHARGE)
(949) 351-9776
Entity
Organization
Contact information
Practice address
10402 WESTMINSTER AVE, STE C, GARDEN GROVE, CA 92843-4861
(714) 534-4133
(714) 534-4052
Mailing address
10402 WESTMINSTER AVE, STE C, GARDEN GROVE, CA 92843-4861
(714) 534-4133
(714) 534-4052
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY50050
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2122922
PK
—
Enumeration date
11/18/2005
Last updated
12/18/2016
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