Healthcare Provider Details

I. General information

NPI: 1922000546
Provider Name (Legal Business Name): BRISTOL DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 N ORANGE GROVE AVE STE 100
POMONA CA
91767-3027
US

IV. Provider business mailing address

1770 N ORANGE GROVE AVE STE 100
POMONA CA
91767-3027
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-6429
  • Fax: 909-623-3539
Mailing address:
  • Phone: 909-623-6429
  • Fax: 909-623-3539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50805
License Number StateCA

VIII. Authorized Official

Name: DAVID LIM
Title or Position: OWNER
Credential:
Phone: 909-623-6429