Active Care Pharmacy Inc
Organization Active NPI Long Term Care Pharmacy · Fountain Valley, CA
NPI 1477061745 · NPPES record last updated Nov 18, 2025
Key facts
- NPI
- 1477061745
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Pharmacy 3336L0003X
- License
- 55862 (CA)
- Legal business name
- ACTIVE CARE PHARMACY INC
- Practice address
- 11770 Warner Ave Ste 101
Fountain Valley, CA 92708-2659 - Phone
- (714) 733-7930
- Fax
- (714) 951-9333
- NPI assigned
- Jan 19, 2018
- Organization subpart
- No
Authorized official
- Name
- Tyrone Nguyen
- Title
- Ceo/Owner
- Phone
- (714) 733-7930
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210810002834 | CA | Part B Supplier - Mass Immunization (Roster Biller Only) | 4789949280 | Practice locations: Fountain Valley, CA |
National Provider Directory
Locations
11770 Warner Ave
Ste 101
Fountain Valley, CA 92708
Phone (714) 576-2222
17050 Bushard St
Ste 300
Fountain Valley, CA 92708
Phone (714) 733-7930
17050 Bushard St
Ste 217
Fountain Valley, CA 92708
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | 55862 | CA | Yes |
Addresses
Primary practice location
11770 Warner Ave Ste 101
Fountain Valley, CA 92708-2659
Mailing address
11770 Warner Ave Ste 101
Fountain Valley, CA 92708-2659
Phone (714) 733-7930
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 57681 | Other | CA | PHARMACY PERMIT |
Other names
- ACTIVE CARE PHARMACY
Other providers in Fountain Valley, CA
- Keith Ryan Aceron
- Acessmd Medical Group, Inc
- Cecilia Rosete Acosta
- Olivia Marie Acosta
- Victoria A Acosta
- Adam Wong MD Inc
- Carol Ann Adams
- Jan Rudalgo Adams
- Maricela Adrian
- Advanced Healthcare Associates, Inc
All providers in Fountain Valley, CA · Long Term Care Pharmacy in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.