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General NPI Number Information
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NPI Number | 1467576538
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Entity Type | Organization
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Legal Business Name | CRANDALL'S MEDICAL PHARMACY
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 360 E 7TH ST STE F
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City | UPLAND
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State | CA
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Zip | 91786-6701
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Country | US
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Telephone | 909-985-6814
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Fax | 909-985-9087
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Provider Business Mailing Address
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Address Line | 360 E 7TH ST STE F
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City | UPLAND
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State | CA
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Zip | 91786-6701
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Country | US
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Telephone | 909-985-6814
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Fax | 909-985-9087
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. ROBERT S IQAL
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Credential | RPH
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Telephone | 909-985-6814
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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 | PHY441704
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License Number State | CA
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