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General NPI Number Information
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NPI Number | 1265796106
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Entity Type | Organization
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Legal Business Name | JMC PHARMACY, INC.
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 02/07/2021
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Provider Practice Location Address
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Address Line | 777 W BLAINE ST
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City | RIVERSIDE
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State | CA
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Zip | 92507-3940
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Country | US
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Telephone | 951-299-9922
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Fax |
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Provider Business Mailing Address
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Address Line | 777 W BLAINE ST
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City | RIVERSIDE
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State | CA
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Zip | 92507-3940
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Country | US
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Telephone | 951-299-9922
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN MICHAEL CHAN
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Credential | PHARMD
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Telephone | 951-299-9922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY50858
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License Number State | CA
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