Provider Demographics
NPI:1740715960
Name:MONTANO, PHILLIP
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:MONTANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 W CHAPMAN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2330
Mailing Address - Country:US
Mailing Address - Phone:714-941-6177
Mailing Address - Fax:714-941-6178
Practice Address - Street 1:2140 W CHAPMAN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2330
Practice Address - Country:US
Practice Address - Phone:714-941-6177
Practice Address - Fax:714-941-6178
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH1639183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician