Provider Demographics
NPI:1104103217
Name:MACH, PETER HAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:HAN
Last Name:MACH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 CORTE MALTERA
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1678
Mailing Address - Country:US
Mailing Address - Phone:714-728-7383
Mailing Address - Fax:
Practice Address - Street 1:1324 CORTE MALTERA
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1678
Practice Address - Country:US
Practice Address - Phone:714-728-7383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist