Healthcare Provider Details

I. General information

NPI: 1912415118
Provider Name (Legal Business Name): APPLE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 SAN BERNARDINO ST STE 110
MONTCLAIR CA
91763-2326
US

IV. Provider business mailing address

5050 SAN BERNARDINO ST STE 110
MONTCLAIR CA
91763-2326
US

V. Phone/Fax

Practice location:
  • Phone: 909-264-1331
  • Fax: 909-330-0933
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number55887
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number55887
License Number StateCA

VIII. Authorized Official

Name: DR. ALYSSA TAMURA
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 909-546-1000