Organization
FAIRVIEW MTM PHARMA, INC
Active
Organization
FAIRVIEW MTM PHARMA, INC
Active
Other names
PROFESSIONAL PHARMACY FAIRVIEW
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DENISE T. LE (PRESIDENT/CEO/PIC)
(714) 881-0012
Entity
Organization
Contact information
Practice address
1002 N FAIRVIEW ST, SANTA ANA, CA 92703-1811
(714) 881-0012
(714) 486-2378
Mailing address
1002 N FAIRVIEW ST, SANTA ANA, CA 92703-1811
(714) 881-0012
(714) 881-4321
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY54449
CA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417306200
—
CA
01
—
PHY 54449
CALIFORNIA STATE BOARD OF PHARMACY PERMIT
CA
Enumeration date
06/13/2016
Last updated
02/20/2023
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