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General NPI Number Information
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NPI Number | 1336525054
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Entity Type | Organization
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Legal Business Name | TARGET
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 3944 GRAND AVE
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City | CHINO
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State | CA
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Zip | 91710-5422
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Country | US
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Telephone | 909-465-5804
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Fax |
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Provider Business Mailing Address
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Address Line | 14369 MOUNTAIN AVE
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City | CHINO
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State | CA
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Zip | 91710-1386
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Country | US
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Telephone | 209-403-8563
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Fax |
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Authorized Official
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Title or Position | PHARMACY BUSINESS PARTNER
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Name | MONICA TRIVEDI
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Credential | RPH
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Telephone | 714-654-4031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 72803
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License Number State | CA
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