Fairview MTM Pharma, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY54449 Issued in CA

Legal business name

FAIRVIEW MTM PHARMA, INC

Doing business as

PROFESSIONAL PHARMACY FAIRVIEW

Practice address

1002 N Fairview St
Santa Ana, CA 92703-1811

Phone

(714) 881-0012

Fax

(714) 486-2378

NPI assigned

Jun 13, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Denise T. Le

Title

President/Ceo/Pic

Phone

(714) 881-0012

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• PROFESSIONAL PHARMACY FAIRVIEW Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676851200000",
    "number": "1417306200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 N FAIRVIEW ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927031811",
            "telephone_number": "714-881-0012",
            "fax_number": "714-881-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 N FAIRVIEW ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927031811",
            "telephone_number": "714-881-0012",
            "fax_number": "714-486-2378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRVIEW MTM PHARMA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-13",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT/CEO/PIC",
        "authorized_official_telephone_number": "714-881-0012",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY54449",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417306200",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA STATE BOARD OF PHARMACY PERMIT",
            "identifier": "PHY 54449",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROFESSIONAL PHARMACY FAIRVIEW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Faculty Physicians and Surgeons of Llusm
• Chelci Fadden, MSW
• Annabelle B Faeldan, RN
• Mark Fagin-Hutchings, D.D.S., M.S
• Gary Martin Fainbarg, DDS
• Faiz Rahman DO Inc
• Emily Fajardo
• Michael Falco
• Janel Cassondra Falcon, LCSW
• Emily Marie Falcone, PT, DPT

• Community/Retail Pharmacy in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.