=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548271034
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POPULAR MEDICAL PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 04/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 S BRISTOL ST
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92703-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-547-4473
-----------------------------------------------------
Fax | 714-547-6433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 S BRISTOL ST
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92703-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-547-4473
-----------------------------------------------------
Fax | 714-547-6433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST OWNER
-----------------------------------------------------
Name | DIANA NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-547-4473
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY43643
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------