Healthcare Provider Details
I. General information
NPI: 1053777136
Provider Name (Legal Business Name): FAMILY CARE INVESTMENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/05/2016
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1150 MAIN ST SUITE D
IRVINE CA
92614-6761
US
IV. Provider business mailing address
1150 MAIN ST SUITE D
IRVINE CA
92614-6761
US
V. Phone/Fax
- Phone: 949-486-6790
- Fax: 858-810-0744
- Phone: 949-486-6790
- Fax: 858-810-0744
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 3336C0003X |
| Taxonomy | Community/Retail Pharmacy |
| License Number | PHY 53937 |
| License Number State | CA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 3336C0004X |
| Taxonomy | Compounding Pharmacy |
| License Number | PHY 53937 |
| License Number State | CA |
VIII. Authorized Official
Name: DR.
ANDREW
M
DO
Title or Position: MEMBER/PIC
Credential: PHARM D
Phone: 949-486-6790