Organization
J & R PHARMACY P C
Active
Other names
JC Neighborhood Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE IBRAHIM RPH (CEO/PIC)
(951) 531-8041
Entity
Organization
Contact information
Practice address
770 MAGNOLIA AVE STE 1G, CORONA, CA 92879-3121
(951) 531-8041
(951) 531-8043
Mailing address
770 MAGNOLIA AVE, STE 1-G, CORONA, CA 92879-3120
(951) 531-8041
(951) 531-8043
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
PHY55570
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306224662
—
CA
01
—
1780273425
IMMUNIZATION
CA
05
—
1780273425
—
CA
01
—
2151943
PK
—
Enumeration date
05/07/2015
Last updated
05/25/2023
Update your record
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