Organization
EXTENDED HOME CARE, INC.
Active
Other names
Extended Homecare Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES J TIEE PHARM. D. (DIRECTOR OF PHARMACY)
(714) 662-5589
Entity
Organization
Contact information
Practice address
3303 HARBOR BLVD, E-6, COSTA MESA, CA 92626-1530
(714) 668-5589
(714) 434-1215
Mailing address
PO BOX 73, CORONA DEL MAR, CA 92625-0073
(714) 662-5589
(714) 454-1215
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PHY462120
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA462120
—
CA
Enumeration date
04/12/2007
Last updated
08/22/2020
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