Organization
RUHS-CORONA PHARMACY
Active
Other names
RUHS-CORONA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVALYN TIDWELL (ASSISTANT DIRECTOR OF PHARMACY)
(951) 486-4527
Entity
Organization
Contact information
Practice address
2813 S MAIN ST, CORONA, CA 92882-5942
(951) 955-0111
(951) 486-4540
Mailing address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(951) 486-4761
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
56092
CA
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177826
PK
—
Enumeration date
06/08/2018
Last updated
06/08/2018
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