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General NPI Number Information
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NPI Number | 1174618862
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Entity Type | Organization
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Legal Business Name | SEVENTH-DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 11161 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-2824
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Country | US
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Telephone | 909-558-4566
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Fax | 909-558-4586
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Provider Business Mailing Address
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Address Line | 11161 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-2824
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Country | US
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Telephone | 909-558-4566
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Fax | 909-558-4586
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Authorized Official
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Title or Position | PHARMACY SUPERVISOR
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Name | EUGENE PARK
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Credential | PHARMD
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Telephone | 909-558-4566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY35986
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License Number State | CA
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