| NPI | 1053968289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERIM BANGOU Pharmacist In Charge 909-597-1821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336I0012X Pharmacy, Institutional Pharmacy |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2019-08-22 |