Healthcare Provider Details

I. General information

NPI: 1316959885
Provider Name (Legal Business Name): PMC PHARMACY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E HUNTINGTON DR SUITE 111
MONROVIA CA
91016-8006
US

IV. Provider business mailing address

222 E HUNTINGTON DR SUITE 111
MONROVIA CA
91016-8006
US

V. Phone/Fax

Practice location:
  • Phone: 800-533-9752
  • Fax: 626-256-6016
Mailing address:
  • Phone: 800-533-9752
  • Fax: 626-256-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY48705
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY47107
License Number StateCA

VIII. Authorized Official

Name: MR. THOMAS A CANERIS
Title or Position: VICE PRESIDENT
Credential:
Phone: 502-627-7100