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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