Organization
GOOD SAMARITAN PHARMACY INC
Active
Other names
GOOD SAMARITAN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MYLENE BUNAGAN (PRESIDENT)
(909) 774-1115
Entity
Organization
Contact information
Practice address
8137 MALACHITE AVE STE A, RANCHO CUCAMONGA, CA 91730-3571
(909) 774-1115
(909) 774-1118
Mailing address
8137 MALACHITE AVE STE A, RANCHO CUCAMONGA, CA 91730-3571
(909) 774-1115
(909) 774-1118
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
56061
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2175562
PK
—
Enumeration date
01/22/2018
Last updated
05/03/2018
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