Healthcare Provider Details

I. General information

NPI: 1750477980
Provider Name (Legal Business Name): MTN PHARMACISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/09/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JOURNEY STE 140A
ALISO VIEJO CA
92656-5336
US

IV. Provider business mailing address

5 JOURNEY 140 A
ALISO VIEJO CA
92656-5336
US

V. Phone/Fax

Practice location:
  • Phone: 949-669-8355
  • Fax:
Mailing address:
  • Phone: 949-669-8355
  • Fax: 949-446-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MINH TRI VAN NGUYEN
Title or Position: PRESIDENT
Credential:
Phone: 504-723-1978