Provider Demographics
NPI:1386754596
Name:WARNER PLAZA PHARMACY
Entity type:Organization
Organization Name:WARNER PLAZA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-965-1008
Mailing Address - Street 1:10810 WARNER AVE
Mailing Address - Street 2:SUITE #9
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3848
Mailing Address - Country:US
Mailing Address - Phone:714-965-1008
Mailing Address - Fax:714-965-7530
Practice Address - Street 1:10810 WARNER AVE
Practice Address - Street 2:SUITE #9
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3848
Practice Address - Country:US
Practice Address - Phone:714-965-1008
Practice Address - Fax:714-965-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY381623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA381620Medicaid
CAPHA381620Medicaid