Provider Demographics
NPI:1477442879
Name:ANTELOPE VALLEY OUTPATIENT PHARMACY
Entity type:Organization
Organization Name:ANTELOPE VALLEY OUTPATIENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:VU
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:661-949-5877
Mailing Address - Street 1:44241 15TH ST W STE 102
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5500
Mailing Address - Country:US
Mailing Address - Phone:661-949-5877
Mailing Address - Fax:
Practice Address - Street 1:44241 15TH ST W STE 102
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5500
Practice Address - Country:US
Practice Address - Phone:661-949-5877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy