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General NPI Number Information
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NPI Number | 1275684474
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Entity Type | Organization
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Legal Business Name | FOUNTAIN VALLEY CANCER CENTER PHARMACY
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 11190 WARNER AVE SUITE 111
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4019
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Country | US
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Telephone | 714-979-3784
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Fax | 714-436-9217
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Provider Business Mailing Address
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Address Line | 11190 WARNER AVE SUITE 111
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4019
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Country | US
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Telephone | 714-979-3784
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Fax | 714-436-9217
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Authorized Official
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Title or Position | PRESIDENT PHARMACIST IN CHARGE
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Name | MR. MARC LOUIS HORWITZ
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Credential | R.PH.
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Telephone | 714-979-3784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY43274
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License Number State | CA
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