HERITAGE COMPOUNDING PHARMACY (NPI# 1093183303) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093183303 |
| Entity Type | Organization |
| Organization Name | HERITAGE COMPOUNDING PHARMACY |
| Practice Address |
2903 Saturn St Ste A Brea CA 92821-6259 |
| Mailing Address |
30802 Coast Hwy Spc. D8 Laguna Beach CA 92651-4207 |
| Practice Telephone | 7145791636 |
| Practice Fax Number | 7145791682 |
| Mailing Telephone | 9492350343 |
| Mailing Fax Number | 7145791682 |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2015-09-03 |
| Authorized Official Name | DR. SYLVIA A MOORE (PHARMACIST IN CHARGE) |
| Authorized Official Telephone | 7145791636 |
| Authorized Official Credential | PHARM.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 22225 | CA | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104964840 | Heritage Compounding Pharmacy | Pharmacy | 2903 Saturn St Ste A, Brea, CA 92821-6259 | 2007-02-02 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | HERITAGE COMPOUNDING PHARMACY, LLC | 11 Midtown Park E, Mobile, AL 36606 |
| North Carolina Corporations | Heritage Compounding Pharmacy, LLC | 3125 Poplar Wood Court, The Aspen Building, Ste. 100, Raleigh, NC 27604 |
| Street Address |
2903 SATURN ST STE A |
| City | BREA |
| State | CA |
| Zip Code | 92821-6259 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104964840 | Heritage Compounding Pharmacy | Pharmacy | 2903 Saturn St Ste A, Brea, CA 92821-6259 | 2007-02-02 |
| 1497147425 | Precision Pharmacy Center, LLC | Pharmacy | 2903 Saturn St Ste A, Brea, CA 92821-6259 | 2015-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043844921 | Christina Marie Iezza | Physical Medicine & Rehabilitation | 500 W. Central Ave, Suite B, Brea, CA 92821 | 2020-02-28 |
| 1962052068 | Joanne Chung | Behavioral Analyst | 3050 Saturn Street, #102, Brea, CA 92821 | 2019-09-19 |
| 1508336736 | Sonia Montez | Physical Therapy Assistant | Jump N Schout, 500 W Central Ave, Brea, CA 92821 | 2018-11-30 |
| 1215411921 | Eye View Optometry, Inc | Optometrist | 605 E. Imperial Hwy, Suite C, Brea, CA 92821 | 2018-09-18 |
| 1700395480 | Sheetal Patel | Registered Nurse | 955 W. Imperial Hwy., Suite 220, Brea, CA 92821 | 2017-09-25 |
| 1952827826 | Grace Cho | Occupational Therapist | 875 N Brea Blvd # 600, Brea, CA 92821 | 2017-08-22 |
| 1063959781 | Veronica Meza | Lactation Consultant, Non-RN | 551 Discovery Lane, #115, Brea, CA 92821 | 2017-01-20 |
| 1780045815 | Audrey Alva | Specialist/Technologist | 460 W. Lambert Road, Brea, CA 92821 | 2016-03-17 |
| 1558734921 | Eun Kim Chiropractic Inc | Chiropractor | 411 Atlas Street, Suite A, Brea, CA 92821 | 2015-11-07 |
| 1053784512 | Caremore Health Plan | Nurse Practitioner | 420 W. Central Avenue #a, Brea, CA 92821 | 2015-11-05 |
| Find all providers in zip 92821 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639717176 | Janna Kim | Pharmacist | 408 N Tapia Ln, Brea, CA 92821-9116 | 2019-12-16 |
| 1053823096 | Jessica Son | Pharmacist | 952 Reynoso Pkwy, Brea, CA 92821-2341 | 2017-10-31 |
| 1801326384 | Garrick Shum | Pharmacist | 385 W Central Ave Ste E, Brea, CA 92821-3000 | 2017-06-15 |
| 1992247175 | Long Nguyen | Pharmacist | 675 Placentia Ave Ste 300, Brea, CA 92821-6167 | 2016-11-05 |
| 1356796064 | Samar El-khoury | Pharmacist | 390 N Brea Blvd, Brea, CA 92821-4005 | 2016-05-01 |
| 1992164396 | Brian Everett Eggleton | Pharmacist | 153 Meadowcreek Rd, Brea, CA 92821-4347 | 2016-02-15 |
| 1912378654 | Sylvia Ann Moore | Pharmacist | 2903 Saturn St, Suite A, Brea, CA 92821-6259 | 2015-10-07 |
| 1063893238 | James Lin | Pharmacist | 2500 E Imperial Hwy Ste 158, Brea, CA 92821-6121 | 2015-06-14 |
| 1982099594 | Jesal Patel | Pharmacist | 3167 E Plains, Brea, CA 92821-6804 | 2015-03-31 |
| 1568706356 | Casey C Kim | Pharmacist | 2667 E Stearns St, Brea, CA 92821-4757 | 2012-11-16 |
| Find all providers in BREA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.