Prestige Medical Solutions

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

52505 Issued in CA

Legal business name

PRESTIGE MEDICAL SOLUTIONS

Doing business as

Prestige Medical Pharmacy

Practice address

17150 Euclid St Ste 222a
Fountain Valley, CA 92708-4092

Phone

(714) 361-1012

Fax

(714) 361-1019

NPI assigned

Aug 12, 2014

Last updated

Apr 25, 2017By 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

Usman Ahmed

Title

Owner

Phone

(714) 361-1012

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Prestige Medical Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

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

{
    "created_epoch": "1407801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493078400000",
    "number": "1730598061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17150 EUCLID ST",
            "address_2": "SUITE A222",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084092",
            "telephone_number": "714-361-1012",
            "fax_number": "714-361-1016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17150 EUCLID ST STE 222A",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084092",
            "telephone_number": "714-361-1012",
            "fax_number": "714-361-1019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE MEDICAL SOLUTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-12",
        "last_updated": "2017-04-25",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "USMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-361-1012"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "52505",
            "primary": true
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2155278",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prestige Medical Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Priority Care Medical Group
• Jessica Sue Proffit, MSW
• Proforma Solutions Corp

• Community/Retail Pharmacy in Fountain Valley, CA
• Providers in Fountain Valley, 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 Apr 25, 2017; 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.

Verify at the official NPI Registry.