Provider Demographics
NPI:1568511723
Name:PIONEER PHARMACY
Entity type:Organization
Organization Name:PIONEER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:GURJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SETHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-968-4447
Mailing Address - Street 1:10990 WARNER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3849
Mailing Address - Country:US
Mailing Address - Phone:714-968-4447
Mailing Address - Fax:714-965-0469
Practice Address - Street 1:10990 WARNER AVE STE A
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3849
Practice Address - Country:US
Practice Address - Phone:714-968-4447
Practice Address - Fax:714-965-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY457673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0550497OtherNABP#
CAPHA457670Medicaid