Healthcare Provider Details

I. General information

NPI: 1376639195
Provider Name (Legal Business Name): CALIFORNIA PHRM SERV INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 E ARROW HWY STE E
AZUSA CA
91702-5612
US

IV. Provider business mailing address

453 E ARROW HWY STE E
AZUSA CA
91702-5612
US

V. Phone/Fax

Practice location:
  • Phone: 626-339-6141
  • Fax: 626-858-0439
Mailing address:
  • Phone: 626-339-6141
  • Fax: 626-858-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY47593
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEE PHELPS
Title or Position: PIC
Credential:
Phone: 626-339-6141