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General NPI Number Information
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NPI Number | 1417306200
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Entity Type | Organization
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Legal Business Name | FAIRVIEW MTM PHARMA, INC
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 1002 N FAIRVIEW ST
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City | SANTA ANA
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State | CA
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Zip | 92703-1811
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Country | US
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Telephone | 714-881-0012
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Fax | 714-486-2378
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Provider Business Mailing Address
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Address Line | 1002 N FAIRVIEW ST
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City | SANTA ANA
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State | CA
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Zip | 92703-1811
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Country | US
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Telephone | 714-881-0012
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Fax | 714-881-4321
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Authorized Official
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Title or Position | PRESIDENT/CEO/PIC
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Name | MRS. DENISE T. LE
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Credential |
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Telephone | 714-881-0012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY54449
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License Number State | CA
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