# CALIFORNIA INSTITUTE FOR MEN PHCY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053968289
- **Authorized official:** KERIM BANGOU PHARMD (PHARMACIST-IN-CHARGE)
- **Authorized official phone:** (909) 597-1821

## Contact information

- **Practice address:** 14901 SO CENTRAL AVE, CHINO, CA 91710
- **Practice address phone:** (909) 597-1821
- **Mailing address:** 14901 SO CENTRAL AVE, CHINO, CA 91710
- **Mailing address phone:** (909) 597-1821

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | — | — | — |
| 3336C0003X | Community/Retail Pharmacy | — | — | — |
| 3336I0012X | Institutional Pharmacy | — | — | Yes |

## Other

- **Enumeration date:** 08/22/2019
- **Last updated:** 08/22/2019