Organization
IRVINE SAND CANYON PHARMACY INC
Active
Other names
TOWN CENTER COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MORT FARINA R.PH. (PRESIDENT)
(310) 880-2537
Entity
Organization
Contact information
Practice address
72624 EL PASEO, SUITE A1, PALM DESERT, CA 92260-3309
(760) 341-3984
(760) 341-4954
Mailing address
8 SCARBOROUGH WAY, ROOM 92270, RANCHO MIRAGE, CA 92270-1624
(310) 880-2537
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
99148
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44047
PHARMACY LICENSE
CA
Enumeration date
02/28/2007
Last updated
08/22/2020
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