Healthcare Provider Details

I. General information

NPI: 1467444059
Provider Name (Legal Business Name): AMERICAN HEALTHCARE AND PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 W VALLEY BLVD
COLTON CA
92324-2249
US

IV. Provider business mailing address

518 W VALLEY BLVD
COLTON CA
92324-2249
US

V. Phone/Fax

Practice location:
  • Phone: 909-422-0444
  • Fax: 909-422-0459
Mailing address:
  • Phone: 909-422-0444
  • Fax: 909-422-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY55977
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY55977
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY55977
License Number StateCA

VIII. Authorized Official

Name: HEJALIN PATEL
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 909-422-0444