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General NPI Number Information
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NPI Number | 1861473878
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Entity Type | Organization
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Legal Business Name | FIESTA PHARMACY,INC
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2709 WESTMINSTER AVE SUITE A2
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City | SANTA ANA
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State | CA
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Zip | 92706-2140
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Country | US
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Telephone | 714-554-0997
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Fax | 714-554-0998
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Provider Business Mailing Address
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Address Line | 2709 WESTMINSTER AVE SUITE A2
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City | SANTA ANA
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State | CA
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Zip | 92706-2140
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Country | US
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Telephone | 714-554-0997
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Fax | 714-554-0998
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Authorized Official
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Title or Position | PIC, CEO
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Name | GUY D. NGUYEN
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Credential | RPH
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Telephone | 714-554-0997
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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 | PHY41512
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License Number State | CA
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