Healthcare Provider Details

I. General information

NPI: 1295281285
Provider Name (Legal Business Name): TUSTIN PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 02/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 NEWPORT AVE
TUSTIN CA
92780-3753
US

IV. Provider business mailing address

13400 NEWPORT AVE
TUSTIN CA
92780-3753
US

V. Phone/Fax

Practice location:
  • Phone: 714-731-1344
  • Fax: 714-731-7363
Mailing address:
  • Phone: 714-731-1344
  • Fax: 714-731-7363

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 NumberPHY53356
License Number StateCA

VIII. Authorized Official

Name: ARCHANA VACHHANI
Title or Position: CEO/SEC./DIR.
Credential:
Phone: 562-569-0522