MTM Pharma Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY 51823 Issued in CA

Legal business name

MTM PHARMA INC

Doing business as

Professional Pharmacy Santa Ana

Practice address

2339 W 1St St
Santa Ana, CA 92703-3503

Phone

(714) 278-4800

Fax

(714) 278-4769

NPI assigned

Mar 17, 2014

Reactivated

Sep 14, 2021

Last updated

Jul 7, 2023By the provider in NPPES

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, RPH

Title

President/Pic

Phone

(714) 278-4800

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• PROFESSIONAL PHARMACY SANTA ANA Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Restore Health Corp

  dba MTM Pharmacy I

  • Community/Retail Pharmacy
  • Garden Grove, CA
  • NPI 1467873927

  O20160418000856

  Same enrollment

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

Locations

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

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688688000000",
    "number": "1659797421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2339 W 1ST ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927033503",
            "telephone_number": "714-278-4800",
            "fax_number": "714-278-4769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2339 W 1ST ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927033503",
            "telephone_number": "714-278-4800",
            "fax_number": "714-278-4769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MTM PHARMA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-17",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "deactivation_date": "2021-09-01",
        "reactivation_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT/PIC",
        "authorized_official_telephone_number": "714-278-4800",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY 51823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY",
            "identifier": "PHY51823",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659797421",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROFESSIONAL PHARMACY SANTA ANA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sovann Mouth
• Juan Moya, LVN
• Lourdes Moyotl, BEHAVIOR TECHNICIAN
• Sayuri Vianey Mozo
• Katherine Mras, RN
• Gina Marie Muallem
• Milton Mucker, CADC II
• Jeremy Muehlhoff
• Ysmael Munoz Mugica
• Annette Mugrditchian, LCSW

• 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 Jul 7, 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.