Organization
ABC PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN MICHAEL CHAN PHARMD (PHARMACIST-IN-CHARGE)
(909) 285-1118
Entity
Organization
Contact information
Practice address
7974 HAVEN AVE, 120, RANCHO CUCAMONGA, CA 91730-3052
(877) 222-4598
Mailing address
7974 HAVEN AVE, 120, RANCHO CUCAMONGA, CA 91730-3052
(877) 222-4598
Taxonomy
Speciality
Code
Description
License number
State
3336M0002X
Mail Order Pharmacy
006449
AZ
3336M0002X
Mail Order Pharmacy
03414
NV
3336M0002X
Mail Order Pharmacy
Primary
63648
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245676618
—
CA
Enumeration date
11/20/2015
Last updated
11/20/2015
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