Organization
AMENA PHARMACY CORP
Active
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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