Provider Demographics
NPI:1447253448
Name:986 INFUSION PHARMACY #1 INC.
Entity type:Organization
Organization Name:986 INFUSION PHARMACY #1 INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-701-1192
Mailing Address - Street 1:4420 E MIRALOMA AVE STE F
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1838
Mailing Address - Country:US
Mailing Address - Phone:714-701-1192
Mailing Address - Fax:714-701-1195
Practice Address - Street 1:4420 E MIRALOMA AVE STE F
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1838
Practice Address - Country:US
Practice Address - Phone:714-701-1192
Practice Address - Fax:714-701-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY40971333600000X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacyGroup - Multi-Specialty