Provider Demographics
NPI:1013219138
Name:PHARMACORE, INC.
Entity Type:Organization
Organization Name:PHARMACORE, INC.
Other - Org Name:TRINITY MISSION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-839-3033
Mailing Address - Street 1:16569 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2344
Mailing Address - Country:US
Mailing Address - Phone:714-839-3033
Mailing Address - Fax:714-839-3078
Practice Address - Street 1:16569 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2344
Practice Address - Country:US
Practice Address - Phone:714-839-3033
Practice Address - Fax:714-839-3078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 555123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5639515OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA6722100001Medicare NSC