Healthcare Provider Details

I. General information

NPI: 1982615514
Provider Name (Legal Business Name): FOOTHILL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 N RIVERSIDE AVE SUITE 170
RIALTO CA
92376-8071
US

IV. Provider business mailing address

1850 N RIVERSIDE AVE SUITE 170
RIALTO CA
92376-8071
US

V. Phone/Fax

Practice location:
  • Phone: 909-874-2385
  • Fax: 909-874-2428
Mailing address:
  • Phone: 909-874-2385
  • Fax: 909-874-2428

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 NumberPHY45239
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT OLIVA
Title or Position: OWNER AND PHARMACIST
Credential:
Phone: 909-874-2385