Healthcare Provider Details

I. General information

NPI: 1114926961
Provider Name (Legal Business Name): PHARM PLUS ACQUISITION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 E HUNTER AVE SUITE 101
ANAHEIM CA
92807-2049
US

IV. Provider business mailing address

5025 PLANO PKWY
CARROLLTON TX
75010-5022
US

V. Phone/Fax

Practice location:
  • Phone: 800-801-1140
  • Fax: 469-365-8274
Mailing address:
  • Phone: 469-365-8287
  • Fax: 844-811-7689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number46321
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number46321
License Number StateCA

VIII. Authorized Official

Name: SANDY L CAMPA
Title or Position: SR. CONSULTANT PAYER RELATIONS
Credential:
Phone: 909-799-4174