Organization
FIESTA PHARMACY,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUY D. NGUYEN RPH (PIC, CEO)
(714) 554-0997
Entity
Organization
Contact information
Practice address
2709 WESTMINSTER AVE, SUITE A2, SANTA ANA, CA 92706-2140
(714) 554-0997
(714) 554-0998
Mailing address
2709 WESTMINSTER AVE, SUITE A2, SANTA ANA, CA 92706-2140
(714) 554-0997
(714) 554-0998
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHY41512
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA415120
—
CA
Enumeration date
11/08/2005
Last updated
08/22/2020
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