# GOOD SAMARITAN PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GOOD SAMARITAN PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548778723
- **Authorized official:** MYLENE BUNAGAN (PRESIDENT)
- **Authorized official phone:** (909) 774-1115

## Contact information

- **Practice address:** 8137 MALACHITE AVE STE A, RANCHO CUCAMONGA, CA 91730-3571
- **Practice address phone:** (909) 774-1115
- **Practice address fax:** (909) 774-1118
- **Mailing address:** 8137 MALACHITE AVE STE A, RANCHO CUCAMONGA, CA 91730-3571
- **Mailing address phone:** (909) 774-1115
- **Mailing address fax:** (909) 774-1118

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 56061 | CA | Yes |

## Other

- **Enumeration date:** 01/22/2018
- **Last updated:** 05/03/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2175562 | PK | — |