Healthcare Provider Details

I. General information

NPI: 1699880625
Provider Name (Legal Business Name): LOMA LINDA HEALTH PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11382 MT. VIEW AVE
LOMA LINDA CA
92354
US

IV. Provider business mailing address

11382 MT. VIEW AVE
LOMA LINDA CA
92354
US

V. Phone/Fax

Practice location:
  • Phone: 909-796-3780
  • Fax: 909-796-5783
Mailing address:
  • Phone: 909-796-3780
  • Fax: 909-796-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUE PARK
Title or Position: OWNER, PIC
Credential: RPH
Phone: 909-796-3780