Healthcare Provider Details

I. General information

NPI: 1750200135
Provider Name (Legal Business Name): MONTINEE MOLLY SANTHAVACHART PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 N PALM AVE STE 210
FRESNO CA
93711-5506
US

IV. Provider business mailing address

10654 ELM ST
LOMA LINDA CA
92354-2411
US

V. Phone/Fax

Practice location:
  • Phone: 800-797-3543
  • Fax:
Mailing address:
  • Phone: 909-800-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: