Fairmont Pharmacy

LBN: Fairmont Pharmacy
Fairmont Pharmacy is an health care organization with primary practice located at 1121 W Vine St #13 , Lodi CA 95240. The organization recently has only one registered license in Suppliers / Long Term Care Pharmacy, which is considered as the primary health care specialty. Fairmont Pharmacy can be contacted via phone (209) 625-8633, or through Tran, Beatle Thien-Phuoc via phone (916) 938-9556.

Contact Information

Primary practice address
1121 W Vine St #13 Lodi CA 95240
Phone: (209) 625-8633
Fax: (209) 625-8629
Website:
Map and Directions
Authorized official contact:
Name: Tran, Beatle Thien-Phuoc PHARMD
Phone: (916) 938-9556

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Long Term Care Pharmacy 3336L0003X

Profile Details

NPI number 1104694371
LBN Legal business name Fairmont Pharmacy
DBA Doing business as
Authorized official Tran, Beatle Thien-Phuoc PHARMD
Entity Organization
Organization subpart 1 Yes
Enumeration date Dec 18th, 2023
Last updated Dec 18th, 2023 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104694371 NPPES
California MEDICAID 1689063331
California Other PHY52074

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