Organization
FOUNTAIN VALLEY CENTRAL PHARMACY INC
Active
Other names
FOUNTAIN VALLEY CENTRAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL LE (OWNER)
(714) 839-5115
Entity
Organization
Contact information
Practice address
11055 WARNER AVE, FOUNTAIN VALLEY, CA 92708-4007
(714) 839-5115
(714) 839-4656
Mailing address
11055 WARNER AVE, FOUNTAIN VALLEY, CA 92708-4007
(714) 839-5115
(714) 839-4656
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY40236
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2116214
PK
—
05
—
PHA402360
—
CA
Enumeration date
08/10/2006
Last updated
12/05/2016
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