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General NPI Number Information
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NPI Number | 1659797421
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Entity Type | Organization
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Legal Business Name | MTM PHARMA INC
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 2339 W 1ST ST
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City | SANTA ANA
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State | CA
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Zip | 92703-3503
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Country | US
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Telephone | 714-278-4800
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Fax | 714-278-4769
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Provider Business Mailing Address
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Address Line | 2339 W 1ST ST
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City | SANTA ANA
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State | CA
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Zip | 92703-3503
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Country | US
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Telephone | 714-278-4800
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Fax | 714-278-4769
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Authorized Official
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Title or Position | PRESIDENT/PIC
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Name | MRS. DENISE T LE
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Credential | RPH
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Telephone | 714-278-4800
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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 |
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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 | PHY 51823
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License Number State | CA
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