Healthcare Provider Details

I. General information

NPI: 1225156706
Provider Name (Legal Business Name): BRIAN MIN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W G STREET
ONTARIO CA
91709
US

IV. Provider business mailing address

13833 EVENING TERRACE DR
CHINO HILLS CA
91709
US

V. Phone/Fax

Practice location:
  • Phone: 909-984-3913
  • Fax: 909-988-4234
Mailing address:
  • Phone: 909-627-3424
  • Fax: 909-988-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: