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NPI Code Detail

MEDICARE: 986 INFUSION PHARMACY #1 INC.

MEDICARE: 986 INFUSION PHARMACY #1 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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1275195778
Entity Type Code : Organization
Provider Name (Legal Business Name) : 986 INFUSION PHARMACY #1 INC.
Provider Business Mailing Address
First Line : 4420 E MIRALOMA AVE STE F
Second Line :
City : ANAHEIM
State : CA
Zip : 92807-1838
Country : US
Telephone Number : 714-701-1192
Fax Number : 714-701-1195
Provider Business Practice Location Address
First Line : 4420 E MIRALOMA AVE STE F
Second Line :
City : ANAHEIM
State : CA
Zip : 92807-1838
Country : US
Telephone Number : 714-701-1192
Fax Number : 714-701-1195
Authorized Official
Title or Position : CEO
Name : DANNY THAI
Credential : PHARM.D.
Telephone Number : 626-456-4132
Provider Enumeration Date : 07/03/2019
Last Update Date : 07/03/2019

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