Provider Demographics
NPI:1699094318
Name:GARCIA, MICHAEL ANTHONY (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:GARCIA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:ANTHONY
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2800 KELLER DR APT 161
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1019
Mailing Address - Country:US
Mailing Address - Phone:714-875-5807
Mailing Address - Fax:
Practice Address - Street 1:3300 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7246
Practice Address - Country:US
Practice Address - Phone:714-641-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist