Active NPI
Tustin Premier Pharmacy Inc
Doing business as Tustin Premier Pharmacy
- Community/Retail Pharmacy
- Orange, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- TUSTIN PREMIER PHARMACY INC
- Doing business as
- Tustin Premier Pharmacy
- Practice address
- 217 S Tustin St
Orange, CA 92866-2321 - Phone
- (714) 790-4085
- Fax
- (714) 790-4086
- NPI assigned
- Oct 26, 2018
- Last updated
- Oct 26, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mary Ibrahim
- Title
- Owner
- Phone
- (714) 790-4085
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | NU | Primary |
Addresses
Primary practice location
217 S Tustin St
Orange, CA 92866-2321
Mailing address
217 S Tustin St
Orange, CA 92866-2321
Phone (714) 790-4085
Other names 1
- Tustin Premier Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190211001232 | CA | DME Supplier - Pharmacy | 3678811098 | Practice locations: Orange, CA |
National Provider Directory
National Provider Directory- Tax ID family
- Tustin Premier Pharmacy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Orange, CA
- NPI 1457183733
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Orange, CA
- NPI 1235600016
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540512000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1540512000000",
"number": "1407323579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 S TUSTIN ST",
"city": "ORANGE",
"state": "CA",
"postal_code": "928662321",
"telephone_number": "714-790-4085",
"fax_number": "714-790-4086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 S TUSTIN ST",
"city": "ORANGE",
"state": "CA",
"postal_code": "928662321",
"telephone_number": "714-790-4085",
"fax_number": "714-790-4086"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TUSTIN PREMIER PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2018-10-26",
"last_updated": "2018-10-26",
"status": "A",
"authorized_official_last_name": "IBRAHIM",
"authorized_official_first_name": "MARY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "714-790-4085"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Tustin Premier Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.