Organization
MDMX CORPORATION
Active
Other names
CORONA SPECIALTY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE MAHEALANI AHN PHARM D (PRESDIENT/ PIC)
(951) 278-1008
Entity
Organization
Contact information
Practice address
1280 CORONA POINTE CT, STE 114, CORONA, CA 92879-1770
(951) 278-1008
(951) 278-1009
Mailing address
1280 CORONA POINTE CT, STE 114, CORONA, CA 92879-1770
(951) 278-1008
(951) 278-1009
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY 50310
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY 50310
CA
3336C0004X
Compounding Pharmacy
PHY 50310
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY 50310
RETAIL PHARMACY PERMIT
CA
Enumeration date
05/24/2010
Last updated
05/24/2010
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