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General NPI Number Information
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NPI Number | 1558418152
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Entity Type | Organization
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Legal Business Name | GORDON'S FAIRVIEW PHARMACY
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2600 WALNUT AVE UNIT F
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City | TUSTIN
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State | CA
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Zip | 92780-7032
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Country | US
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Telephone | 714-389-4826
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Fax | 714-389-4821
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Provider Business Mailing Address
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Address Line | 2600 WALNUT AVE UNIT F
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City | TUSTIN
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State | CA
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Zip | 92780-7032
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Country | US
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Telephone | 714-389-4826
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Fax | 714-389-4821
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Authorized Official
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Title or Position | OWER
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Name | MR. SAU VAN TRAN
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Credential | RPH
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Telephone | 714-389-4826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY46099
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License Number State | CA
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