Organization
MINI THUONG XA PHARMACY INC
Active
Other names
MINI THUONG XA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
NAM PHAM RPH (PRESIDENT)
(773) 230-2699
Entity
Organization
Contact information
Practice address
1069 W ARGYLE ST, CHICAGO, IL 60640-3707
(773) 728-1007
(773) 728-7267
Mailing address
PO BOX 408975, CHICAGO, IL 60640-0023
(773) 728-1007
(773) 728-7267
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054009321
IL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2022077
PK
—
Enumeration date
01/22/2007
Last updated
12/17/2015
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