=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336655661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED PHARMACY SOLUTIONS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2017
-----------------------------------------------------
Last Update Date | 12/22/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13841 ROSWELL AVE STE I
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-5467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-312-4972
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13841 ROSWELL AVE STE I
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-5467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-312-4972
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARK M MAHFOUZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-312-4972
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 55882
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------