Organization
IRVINE MEDICAL PHARMACY INC
Active
Other names
IRVINE MEDICAL PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
NASSER FATHI PHRM (PIC)
(949) 552-7777
Entity
Organization
Contact information
Practice address
14130 CULVER DR, STE D, IRVINE, CA 92604-0314
(949) 552-7777
(949) 552-7292
Mailing address
14130 CULVER DR, STE D, IRVINE, CA 92604-0314
(949) 552-7777
(949) 552-7292
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PHY42046
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0568634
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA420460
—
CA
Enumeration date
10/31/2006
Last updated
03/14/2013
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