Organization
BUNGA TERATAI CEMERIANG AMERICA INC
Active
Other names
Ken Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SUKEN JONG (OWNER)
(909) 579-0719
Entity
Organization
Contact information
Practice address
583 E FOOTHILL BLVD, UNITS 7 AND 8, UPLAND, CA 91786-3995
(909) 579-0719
(909) 579-0721
Mailing address
583 E FOOTHILL BLVD, UNITS 7 & 8, UPLAND, CA 91786-3995
(909) 579-0719
(909) 579-0721
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY54391
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881040863
—
CA
01
—
2160375
PK
—
Enumeration date
05/10/2016
Last updated
07/05/2016
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