Healthcare Provider Details

I. General information

NPI: 1235431768
Provider Name (Legal Business Name): ABIFADEL PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2010
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E 7TH ST STE F
UPLAND CA
91786-6701
US

IV. Provider business mailing address

360 E 7TH ST STE F
UPLAND CA
91786-6701
US

V. Phone/Fax

Practice location:
  • Phone: 909-946-6411
  • Fax: 909-946-6441
Mailing address:
  • Phone: 909-946-6411
  • Fax: 909-946-6441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50475
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NAJY ABIFADEL
Title or Position: PIC/OWNER
Credential:
Phone: 909-946-6411