Healthcare Provider Details

I. General information

NPI: 1831381904
Provider Name (Legal Business Name): GUIDED ALLIANCE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27111 ALISO CREEK RD STE 185A
ALISO VIEJO CA
92656-3365
US

IV. Provider business mailing address

34145 PACIFIC COAST HWY STE 195
DANA POINT CA
92629-2808
US

V. Phone/Fax

Practice location:
  • Phone: 949-496-4106
  • Fax: 866-210-9757
Mailing address:
  • Phone: 949-496-3906
  • Fax: 866-210-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number53425
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY MCFADDEN
Title or Position: PRESIDENT
Credential:
Phone: 949-496-3906