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NPI Code Detail

MEDICARE: FIESTA PHARMACY,INC

MEDICARE: FIESTA PHARMACY,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
1333600000XPharmacyPHY41512CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

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

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Directions to “FIESTA PHARMACY,INC ” Practice Location

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