Healthcare Provider Details

I. General information

NPI: 1568495976
Provider Name (Legal Business Name): ARROWMED LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9057 ARROW RTE 170 C
RANCHO CUCAMONGA CA
91730-4452
US

IV. Provider business mailing address

9057 ARROW RTE 170 C
RANCHO CUCAMONGA CA
91730-4452
US

V. Phone/Fax

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

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 NumberPHY47175
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BERLINDA PHOMMALAYHANE
Title or Position: OWNER
Credential:
Phone: 909-476-1992