MEDICARE: NATICO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PHY46902	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5626621	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1184765695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATICO INC

Provider Business Mailing Address
First Line	:	12526 WESTMINSTER AVE
Second Line	:	STE B
City	:	SANTA ANA
State	:	CA
Zip	:	92706-2166
Country	:	US
Telephone Number	:	714-554-1111
Fax Number	:	714-554-7777

Provider Business Practice Location Address
First Line	:	12526 WESTMINSTER AVE
Second Line	:	STE B
City	:	SANTA ANA
State	:	CA
Zip	:	92706-2166
Country	:	US
Telephone Number	:	714-554-1111
Fax Number	:	714-554-7777

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PHUONG NGUYEN
Credential	:	RPH
Telephone Number	:	714-554-1111

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	03/20/2015

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Directions to “NATICO INC ” Practice Location

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