Provider Demographics
NPI:1417101148
Name:SPECTRUM PHARMACY
Entity Type:Organization
Organization Name:SPECTRUM PHARMACY
Other - Org Name:SPECTRUM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-679-3388
Mailing Address - Street 1:18 ENDEAVOR STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3180
Mailing Address - Country:US
Mailing Address - Phone:949-679-3388
Mailing Address - Fax:949-679-7289
Practice Address - Street 1:18 ENDEAVOR STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3180
Practice Address - Country:US
Practice Address - Phone:949-679-3388
Practice Address - Fax:949-679-7289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY488363336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118296OtherPK