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General NPI Number Information
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NPI Number | 1326125295
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Entity Type | Organization
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Legal Business Name | IRVINE MEDICAL PHARMACY INC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 14130 CULVER DR STE D
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City | IRVINE
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State | CA
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Zip | 92604-0314
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Country | US
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Telephone | 949-552-7777
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Fax | 949-552-7292
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Provider Business Mailing Address
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Address Line | 14130 CULVER DR STE D
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City | IRVINE
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State | CA
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Zip | 92604-0314
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Country | US
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Telephone | 949-552-7777
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Fax | 949-552-7292
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Authorized Official
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Title or Position | PIC
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Name | NASSER FATHI
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Credential | PHRM
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Telephone | 949-552-7777
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY42046
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License Number State | CA
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