Fountain Valley Central Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY40236 Issued in CA

Legal business name

FOUNTAIN VALLEY CENTRAL PHARMACY INC

Practice address

11055 Warner Ave
Fountain Valley, CA 92708-4007

Phone

(714) 839-5115

Fax

(714) 839-4656

NPI assigned

Aug 10, 2006

Organization subpart

No

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

Authorized official

Name

Daniel Le

Title

Owner

Phone

(714) 839-5115

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• FOUNTAIN VALLEY CENTRAL PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kha D Le, RPH

  • Pharmacist
  • Fountain Valley, CA
  • NPI 1023006731
  NPD

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480896000000",
    "number": "1831100429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11055 WARNER AVE",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084007",
            "telephone_number": "714-839-5115",
            "fax_number": "714-839-4656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11055 WARNER AVE",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084007",
            "telephone_number": "714-839-5115",
            "fax_number": "714-839-4656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN VALLEY CENTRAL PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2016-12-05",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-839-5115"
    },
    "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": "PHY40236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA402360",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2116214",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOUNTAIN VALLEY CENTRAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Asiah Fortuna
• Brooke Ariel Foster, OTR, OTD
• Fountain Valley Anesthesiology Medical Associates, Inc.
• Fountain Valley Cancer Center Pharmacy
• Fountain Valley Cardiology Medical Clinic Inc.
• Fountain Valley Community Healthcare, LLC
• Fountain Valley Emergency Physicians, P.C.
• Fountain Valley Heallthcare Center
• Fountain Valley Hospitalist Medical Group
• Fountain Valley Integrative Physical Medicine

• All providers in Fountain Valley, CA
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; 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.