MEDICARE: INLAND EMPIRE PHARMACY SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1437667094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND EMPIRE PHARMACY SERVICES INC

Provider Business Mailing Address
First Line	:	1535 E HIGHLAND AVE STE A
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4682
Country	:	US
Telephone Number	:	909-881-0088
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 E HIGHLAND AVE STE A
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4682
Country	:	US
Telephone Number	:	909-881-0088
Fax Number	:

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	DR. NGUYEN DUC DAO
Credential	:	PHARM.D.
Telephone Number	:	909-881-0088

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	01/17/2018

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