Healthcare Provider Details

I. General information

NPI: 1578646626
Provider Name (Legal Business Name): FL & CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NEWPORT CENTER DR SUITE 106
NEWPORT BEACH CA
92660-7601
US

IV. Provider business mailing address

PO BOX 54468
IRVINE CA
92619-4468
US

V. Phone/Fax

Practice location:
  • Phone: 949-719-3707
  • Fax: 949-719-3713
Mailing address:
  • Phone: 949-719-3707
  • Fax: 949-719-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5998960001
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY48317
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIAN LYN
Title or Position: VICE PRESIDENT
Credential: PHARMD
Phone: 949-719-3707