Organization
CALIFORNIA INSTITUE FOR MEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KERIM BANGOU PHARM.D (PHARMACIST INCHARGE)
(909) 597-1821
Entity
Organization
Contact information
Practice address
14901 CENTRAL AVE, CHINO, CA 91710-9500
(909) 597-1821
(909) 606-4332
Mailing address
14901 CENTRAL AVE, CHINO, CA 91710-9500
(909) 597-1821
(909) 606-4332
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
44274
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44274
PHARMACIST LICENCE NUMBER
CA
Enumeration date
03/28/2014
Last updated
03/28/2014
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