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General NPI Number Information
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NPI Number | 1538231311
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN PHARMACY INC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 629 W COVINA BLVD
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City | SAN DIMAS
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State | CA
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Zip | 91773-2913
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Country | US
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Telephone | 909-305-0358
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Fax | 909-394-5649
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Provider Business Mailing Address
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Address Line | 629 W COVINA BLVD
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City | SAN DIMAS
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State | CA
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Zip | 91773-2913
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Country | US
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Telephone | 909-305-0358
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Fax | 909-394-5649
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Authorized Official
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Title or Position | CEO
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Name | MYLENE BUNAGAN
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Credential |
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Telephone | 909-305-0358
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY55628
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License Number State | CA
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