Healthcare Provider Details

I. General information

NPI: 1053054296
Provider Name (Legal Business Name): APPLE SPECIALTY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N. BROADWAY STE. 300
SANTA ANA CA
92701
US

IV. Provider business mailing address

1211 N BROADWAY STE 300
SANTA ANA CA
92701-3411
US

V. Phone/Fax

Practice location:
  • Phone: 818-456-0481
  • Fax: 530-698-0991
Mailing address:
  • Phone: 818-456-0481
  • Fax: 530-698-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHAHROKH SHAWN AHOUBIM
Title or Position: MANAGER
Credential:
Phone: 818-456-0481