Organization
IVY PHARMA INC
Active
Other names
IVY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ASHRAF ALFRED PHARM D (PRESIDENT/CEO)
(909) 321-5588
Entity
Organization
Contact information
Practice address
16854 IVY AVE STE C, FONTANA, CA 92335-1504
(909) 321-5588
(909) 321-5595
Mailing address
16854 IVY AVE STE C, FONTANA, CA 92335-1504
(909) 321-5588
(909) 321-5595
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY59123
BOARD OF PHARMACY
CA
Enumeration date
07/18/2023
Last updated
07/18/2023
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