Healthcare Provider Details

I. General information

NPI: 1972514479
Provider Name (Legal Business Name): CHINO HILLS PROFESSIONAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 GRAND AVE STE 130
CHINO HILLS CA
91709-6800
US

IV. Provider business mailing address

2140 GRAND AVE STE 130
CHINO HILLS CA
91709-6800
US

V. Phone/Fax

Practice location:
  • Phone: 909-364-9244
  • Fax: 909-364-9222
Mailing address:
  • Phone: 909-364-9244
  • Fax: 909-364-9222

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 NumberPHY46559
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NITIN PATEL
Title or Position: PRESIDENT
Credential:
Phone: 909-364-9244