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Organization
GOOD SAMARITAN PHARMACY INC
Active
Organization
GOOD SAMARITAN PHARMACY INC
Active
Other names
GOOD SAMARITAN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MYLENE BUNAGAN (PRESIDENT)
(909) 774-1115
Entity
Organization
Contact information
Practice address
8137 MALACHITE AVE STE A, RANCHO CUCAMONGA, CA 91730-3571
(909) 774-1115
(909) 774-1118
Mailing address
8137 MALACHITE AVE STE A, RANCHO CUCAMONGA, CA 91730-3571
(909) 774-1115
(909) 774-1118
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
56061
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2175562
PK
—
Enumeration date
01/22/2018
Last updated
05/03/2018
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