1972505592 NPI number — CBC PROFESSIONAL PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972505592 NPI number — CBC PROFESSIONAL PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CBC PROFESSIONAL PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972505592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2095 W ARROW RTE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-4210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-982-4843
Provider Business Mailing Address Fax Number:
909-982-4967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92411-1356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-887-6359
Provider Business Practice Location Address Fax Number:
909-887-9890
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FREED
Authorized Official First Name:
MARLA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-982-4843

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHA398760 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0562961 . This is a "NABP#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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