Healthcare Provider Details

I. General information

NPI: 1295051779
Provider Name (Legal Business Name): WESTERN UNIVERSITY OF HEALTH SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E 2ND ST STE 1
POMONA CA
91766-2007
US

IV. Provider business mailing address

795 E 2ND ST STE 1
POMONA CA
91766-2007
US

V. Phone/Fax

Practice location:
  • Phone: 909-706-3730
  • Fax: 909-706-3731
Mailing address:
  • Phone: 909-706-3730
  • Fax: 909-706-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number50259
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number50259
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50259
License Number StateCA

VIII. Authorized Official

Name: PREETI KOTHA
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 909-706-3765