1588937478 NPI number — SPECTRUM PHARMACY

Table of content: (NPI 1588937478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588937478 NPI number — SPECTRUM PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRUM PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SPECTRUM PHARMACY-ANAHEIM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588937478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1236 N MAGNOLIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92801-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-826-6246
Provider Business Mailing Address Fax Number:
714-826-1810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1236 N MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92801-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-826-6246
Provider Business Practice Location Address Fax Number:
714-826-1810
Provider Enumeration Date:
02/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TRAN
Authorized Official First Name:
NINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
949-257-3748

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY50751 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2133935 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1588937478 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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