Healthcare Provider Details

I. General information

NPI: 1780836676
Provider Name (Legal Business Name): JC MAX PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 E FOOTHILL BLVD
RIALTO CA
92376-5230
US

IV. Provider business mailing address

826 E FOOTHILL BLVD
RIALTO CA
92376-5230
US

V. Phone/Fax

Practice location:
  • Phone: 909-546-1000
  • Fax: 909-546-1010
Mailing address:
  • Phone: 909-546-1000
  • Fax: 909-546-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY49030
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TONY CHAN
Title or Position: OWNER
Credential: PHARMD
Phone: 909-946-5512