Organization
LAKE ARROWHEAD VILLAGE PHARMACY
Active
Organization
LAKE ARROWHEAD VILLAGE PHARMACY
Active
Other names
LAKE ARROWHEAD VILLAGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE BLAIN (PRESIDENT)
(909) 336-0120
Entity
Organization
Contact information
Practice address
28200 ST HWY 189, LAKE ARROWHEAD, CA 92352-9700
(909) 336-0120
(909) 336-0140
Mailing address
PO BOX 2945, LAKE ARROWHEAD, CA 92352-2945
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY46040
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0588600
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA460400
—
CA
Enumeration date
11/29/2006
Last updated
07/25/2011
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