MEDICARE: MY FIRST PHARMACY CORPORATION

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	3336M0002X	Mail Order Pharmacy
2	333600000X	Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336C0003X	Community/Retail Pharmacy	PHY47467	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5618256	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215963913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY FIRST PHARMACY CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 7144
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92615-7144
Country	:	US
Telephone Number	:	951-207-3315
Fax Number	:	951-272-6322

Provider Business Practice Location Address
First Line	:	1820 FULLERTON AVE
Second Line	:	STE 145
City	:	CORONA
State	:	CA
Zip	:	92881-3160
Country	:	US
Telephone Number	:	951-272-6000
Fax Number	:	951-272-6322

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DUAINE R ARVIDSON
Credential	:	MBA
Telephone Number	:	951-207-3315

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	06/10/2011

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Directions to “MY FIRST PHARMACY CORPORATION ” Practice Location

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