Organization
ST CYRIL INC
Active
Other names
Mesa Verde Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GENEVIEVE BENJAMIN PHARM D (CEO/ PRESIDENT)
(949) 293-9857
Entity
Organization
Contact information
Practice address
1525 MESA VERDE DR E STE 101, COSTA MESA, CA 92626-5221
(714) 884-3574
(714) 486-1027
Mailing address
1525 MESA VERDE DR E STE 101, COSTA MESA, CA 92626-5221
(714) 884-3574
(714) 486-1027
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY56036
CA
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2152982
PK
—
Enumeration date
06/25/2015
Last updated
02/08/2024
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