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General NPI Number Information
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NPI Number | 1417837204
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Entity Type | Individual
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Provider Name | JAMES BOSE HARIYANTO PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 17100 EUCLID ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4004
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Country | US
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Telephone | 714-966-7200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8502
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-0502
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Country | US
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Telephone | 949-331-7160
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 91125
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License Number State | CA
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