Provider Demographics
NPI:1578646626
Name:FL & CO
Entity Type:Organization
Organization Name:FL & CO
Other - Org Name:NEWPORT COAST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:949-719-3707
Mailing Address - Street 1:PO BOX 54468
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-4468
Mailing Address - Country:US
Mailing Address - Phone:949-719-3707
Mailing Address - Fax:949-719-3713
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 106
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-719-3707
Practice Address - Fax:949-719-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5998960001332B00000X
CAPHY48317333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0501115OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA483170Medicaid
0501115OtherOTHER ID NUMBER-COMMERCIAL NUMBER