Provider Demographics
NPI: | 1497147425 |
---|---|
Name: | PRECISION PHARMACY CENTER, LLC |
Entity Type: | Organization |
Organization Name: | PRECISION PHARMACY CENTER, LLC |
Other - Org Name: | HERITAGE PHARMACY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PHARMACIST IN CHARGE |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SYLVIA |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | MOORE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHARM D |
Authorized Official - Phone: | 714-579-1636 |
Mailing Address - Street 1: | 2903 SATURN ST STE A |
Mailing Address - Street 2: | |
Mailing Address - City: | BREA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92821-6259 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-579-1636 |
Mailing Address - Fax: | 714-579-1682 |
Practice Address - Street 1: | 2903 SATURN ST STE A |
Practice Address - Street 2: | |
Practice Address - City: | BREA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92821-6259 |
Practice Address - Country: | US |
Practice Address - Phone: | 714-579-1636 |
Practice Address - Fax: | 714-579-1682 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-02-27 |
Last Update Date: | 2015-02-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 333600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 333600000X | Suppliers | Pharmacy |