Healthcare Provider Details

I. General information

NPI: 1184639734
Provider Name (Legal Business Name): ANAHEIM HILLS MEDICAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S ANAHEIM HILLS RD STE 100 STE 100
ANAHEIM CA
92807-4761
US

IV. Provider business mailing address

500 S ANAHEIM HILLS RD STE 100 STE 100
ANAHEIM CA
92807
US

V. Phone/Fax

Practice location:
  • Phone: 714-279-1111
  • Fax: 714-279-1115
Mailing address:
  • Phone: 714-279-1111
  • Fax: 714-279-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number43794
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOJGAN REZAEI
Title or Position: OWNER
Credential: PHARM.D
Phone: 714-279-1111