Healthcare Provider Details

I. General information

NPI: 1578128088
Provider Name (Legal Business Name): RADIANCE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 COMMERCENTER WEST
SAN BERNARDINO CA
92408-3300
US

IV. Provider business mailing address

1823 COMMERCENTER WEST
SAN BERNARDINO CA
92408-3300
US

V. Phone/Fax

Practice location:
  • Phone: 909-333-4567
  • Fax: 909-333-4564
Mailing address:
  • Phone: 909-333-4567
  • Fax: 909-333-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NIKUNJ C DHAMI
Title or Position: PRESIDENT/CEO
Credential:
Phone: 909-333-4567