Healthcare Provider Details

I. General information

NPI: 1417101148
Provider Name (Legal Business Name): SPECTRUM PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ENDEAVOR STE 100
IRVINE CA
92618-3180
US

IV. Provider business mailing address

18 ENDEAVOR STE 100
IRVINE CA
92618-3180
US

V. Phone/Fax

Practice location:
  • Phone: 949-679-3388
  • Fax: 949-679-7289
Mailing address:
  • Phone: 949-679-3388
  • Fax: 949-679-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY48836
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TINA LI
Title or Position: MANAGER
Credential:
Phone: 949-679-3388