Organization
BROADWAY MEDICAL PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VAN THI LE (PHARMACIST IN CHARGE/OWNER)
(714) 772-3630
Entity
Organization
Contact information
Practice address
1673 W BROADWAY STE 1, ANAHEIM, CA 92802-1109
(714) 772-3630
Mailing address
1673 W BROADWAY STE 1, ANAHEIM, CA 92802-1109
(714) 772-3630
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY48442
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA484420
—
CA
Enumeration date
01/10/2008
Last updated
01/10/2008
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