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General NPI Number Information
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NPI Number | 1780836676
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Entity Type | Organization
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Legal Business Name | JC MAX PHARMACY INC
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 826 E FOOTHILL BLVD
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City | RIALTO
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State | CA
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Zip | 92376-5230
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Country | US
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Telephone | 909-546-1000
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Fax | 909-546-1010
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Provider Business Mailing Address
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Address Line | 826 E FOOTHILL BLVD
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City | RIALTO
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State | CA
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Zip | 92376-5230
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Country | US
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Telephone | 909-546-1000
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Fax | 909-546-1010
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Authorized Official
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Title or Position | OWNER
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Name | TONY CHAN
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Credential | PHARMD
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Telephone | 909-946-5512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care 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 | PHY49030
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License Number State | CA
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