Organization
AMENA PHARMACY CORP
Active
Other names
HEALTHCARE PHARMACy
Organization subpart
No
Provider details
NPI number
Authorized official
FAREED ENTEZAR PHARMD (PHARMACIST IN CHARGE)
(714) 669-4000
Entity
Organization
Contact information
Practice address
14642 NEWPORT AVE, TUSTIN, CA 92780-6057
(714) 669-4000
(714) 669-4484
Mailing address
14642 NEWPORT AVE, TUSTIN, CA 92780-6057
(714) 669-4000
(714) 669-4484
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY55952
CA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1999991
PK
—
Enumeration date
02/07/2007
Last updated
07/19/2018
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