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Organization
CALIFORNIA INSTITUTE FOR MEN PHCY
Active
Organization
CALIFORNIA INSTITUTE FOR MEN PHCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERIM BANGOU PHARMD (PHARMACIST-IN-CHARGE)
(909) 597-1821
Entity
Organization
Contact information
Practice address
14901 SO CENTRAL AVE, CHINO, CA 91710
(909) 597-1821
Mailing address
14901 SO CENTRAL AVE, CHINO, CA 91710
(909) 597-1821
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
—
—
Other
Enumeration date
08/22/2019
Last updated
08/22/2019
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