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General NPI Number Information
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NPI Number | 1831573963
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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 | 07/18/2015
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 12730 HEACOCK ST STE 1
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City | MORENO VALLEY
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State | CA
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Zip | 92553-3040
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Country | US
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Telephone | 951-924-4990
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Fax | 951-924-4992
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Provider Business Mailing Address
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Address Line | 1301 PASEO GRANDE
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City | CORONA
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State | CA
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Zip | 92882-3702
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Country | US
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Telephone | 499-232-4215
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Fax | 951-924-4992
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Authorized Official
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Title or Position | OWNER, AO
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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 | PHY53649
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License Number State | CA
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