Healthcare Provider Details

I. General information

NPI: 1972772804
Provider Name (Legal Business Name): ARROWMED LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9057 ARROW ROUTE SUITE 170C
RANCHO CUCAMONGA CA
91730-4452
US

IV. Provider business mailing address

9057 ARROW ROUTE SUITE 170C
RANCHO CUCAMONGA CA
91730-4452
US

V. Phone/Fax

Practice location:
  • Phone: 909-476-1992
  • Fax: 909-476-7747
Mailing address:
  • Phone: 909-476-1992
  • Fax: 909-476-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberPHY47175
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY47175
License Number StateCA

VIII. Authorized Official

Name: MISS BERLINDA PHOMMALAYVANE
Title or Position: CEO
Credential: PHARMACY TECH
Phone: 909-466-6701