OrganizationMesa PharmacyPharmacySuppliersPractice Address14085 Newport Ave, Tustin, CA 92780-5172(714) 505-2231PECOS EnrollmentBased on the most recent information from CMS, provider Mesa Pharmacy does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1033124664Provider TypeOrganizationFull NameMesa PharmacySubpartNoEnumeration Date7/30/2006Last Updated8/22/2020Contact InformationPractice LocationPractice Address14085 Newport Ave, Tustin, CA 92780-5172Phone(714) 505-2231Fax(714) 505-2235Mailing LocationMailing Address14085 Newport Ave, Tustin, CA 92780-5172PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameDo, Mytu (Owner)Phone(714) 425-2706Provider TaxonomiesCodeDescriptionLicenseCode333600000XDescriptionPharmacySuppliersLicensePHY47404CaliforniaCode3336C0003XDescriptionPharmacySuppliersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID5618244DescriptionOtherIssuerOTHER ID NUMBER-COMMERCIAL NUMBER