Healthcare Provider Details

I. General information

NPI: 1548547235
Provider Name (Legal Business Name): YDS PHARMACY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 N RIVERSIDE AVE STE 170
RIALTO CA
92376-8056
US

IV. Provider business mailing address

PO BOX 968
ATWOOD CA
92811-0968
US

V. Phone/Fax

Practice location:
  • Phone: 909-546-1300
  • Fax: 909-546-1304
Mailing address:
  • Phone: 714-798-5808
  • Fax: 760-269-3142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50787
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRANDON HUYNH
Title or Position: PRESIDENT
Credential:
Phone: 760-927-3710