Healthcare Provider Details

I. General information

NPI: 1649957374
Provider Name (Legal Business Name): BAN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43839 15TH ST W STE P
LANCASTER CA
93534-4756
US

IV. Provider business mailing address

43839 15TH ST W STE P
LANCASTER CA
93534-4756
US

V. Phone/Fax

Practice location:
  • Phone: 661-200-0562
  • Fax: 866-291-1447
Mailing address:
  • Phone: 661-200-0562
  • Fax: 866-291-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KELLY PHAM
Title or Position: CEO
Credential: PHARMD
Phone: 661-200-0562