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Organization
TUSTIN HOSPITAL AND MEDICAL CENTER
Active
Organization
TUSTIN HOSPITAL AND MEDICAL CENTER
Active
Other names
TUSTIN HOSPITAL AND MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
FAREED ENTEZAR PHARMD (PHARMACY DIRECTOR)
(714) 669-5874
Entity
Organization
Contact information
Practice address
14662 NEWPORT AVE, TUSTIN, CA 92780-6064
(714) 669-5874
(714) 669-2011
Mailing address
14662 NEWPORT AVE, TUSTIN, CA 92780-6064
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
HSP43375
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0555322
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHB433750
—
CA
05
—
PHB499750
—
CA
Enumeration date
04/02/2007
Last updated
02/18/2009
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