MEDICARE: PIONEER PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PHY45767	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0550497	OTHER	CA	NABP#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568511723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIONEER PHARMACY

Provider Business Mailing Address
First Line	:	10990 WARNER AVE STE A
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-3849
Country	:	US
Telephone Number	:	714-968-4447
Fax Number	:	714-965-0469

Provider Business Practice Location Address
First Line	:	10990 WARNER AVE STE A
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-3849
Country	:	US
Telephone Number	:	714-968-4447
Fax Number	:	714-965-0469

Authorized Official
Title or Position	:	PRESIDENT-PHARMACIST IN CHARGE
Name	:	MR. GURJIT SETHI
Credential	:
Telephone Number	:	714-968-4447

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	08/22/2020

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Directions to “PIONEER PHARMACY ” Practice Location

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