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General NPI Number Information
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NPI Number | 1295281285
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Entity Type | Organization
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Legal Business Name | TUSTIN PHARMACY, INC.
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 13400 NEWPORT AVE
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City | TUSTIN
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State | CA
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Zip | 92780-3753
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Country | US
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Telephone | 714-731-1344
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Fax | 714-731-7363
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Provider Business Mailing Address
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Address Line | 13400 NEWPORT AVE
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City | TUSTIN
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State | CA
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Zip | 92780-3753
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Country | US
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Telephone | 714-731-1344
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Fax | 714-731-7363
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Authorized Official
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Title or Position | CEO/SEC./DIR.
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Name | ARCHANA VACHHANI
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Credential |
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Telephone | 562-569-0522
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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 | PHY53356
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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