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General NPI Number Information
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NPI Number | 1346605706
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Entity Type | Organization
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Legal Business Name | B P L P A PHARMACY CORPORATION
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 2220 CLARK AVE
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City | LONG BEACH
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State | CA
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Zip | 90815-2521
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Country | US
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Telephone | 909-877-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 17691 SAN BERNARDINO AVE
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City | FONTANA
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State | CA
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Zip | 92335-5911
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Country | US
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Telephone | 909-877-4224
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GEORGE IBRAHIM
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Credential |
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Telephone | 909-877-4224
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY 53860
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License Number State | CA
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