Healthcare Provider Details

I. General information

NPI: 1013029941
Provider Name (Legal Business Name): HARBOR DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 MESA VERDE DR E
COSTA MESA CA
92626-5218
US

IV. Provider business mailing address

1525 MESA VERDE DR E
COSTA MESA CA
92626-5218
US

V. Phone/Fax

Practice location:
  • Phone: 714-540-8911
  • Fax: 714-435-0261
Mailing address:
  • Phone: 877-540-4748
  • Fax: 801-716-4872

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 NumberPHY37415
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHARLES BONNER
Title or Position: PRESIDENT
Credential:
Phone: 714-540-8911