Organization
B P L P A PHARMACY CORPORATION
Active
Organization
B P L P A PHARMACY CORPORATION
Active
Other names
Orange Express Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE IBRAHIM (OWNER, AO)
(909) 877-4224
Entity
Organization
Contact information
Practice address
12730 HEACOCK ST STE 1, MORENO VALLEY, CA 92553-3040
(951) 924-4990
(951) 924-4992
Mailing address
1301 PASEO GRANDE, CORONA, CA 92882-3702
(499) 232-4215
(951) 924-4992
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY53649
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831573963
—
CA
01
—
2154167
PK
—
Enumeration date
07/18/2015
Last updated
10/02/2018
Update your record
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