Organization
KNIGHTS JXL PHARMACY INC
Active
Other names
ICON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JIAJUN XUE (PRESIDENT/CEO)
(714) 962-7192
Entity
Organization
Contact information
Practice address
18120 BROOKHURST ST STE 57, FOUNTAIN VALLEY, CA 92708-6727
(714) 962-7192
(714) 962-1741
Mailing address
18120 BROOKHURST ST STE 57, FOUNTAIN VALLEY, CA 92708-6727
(714) 962-7192
(714) 962-1741
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY60693
BOARD OF PHARMACY
CA
Enumeration date
04/15/2014
Last updated
04/16/2025
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