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General NPI Number Information
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NPI Number | 1902186224
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Entity Type | Organization
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Legal Business Name | CAMBRIDGE PHARMACY INC
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 08/17/2011
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Provider Practice Location Address
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Address Line | 14101 MAIN ST STE 103
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City | HESPERIA
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State | CA
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Zip | 92345-8098
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Country | US
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Telephone | 909-867-9083
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Fax | 909-867-9086
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Provider Business Mailing Address
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Address Line | 14101 MAIN ST STE 103
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City | HESPERIA
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State | CA
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Zip | 92345-8098
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Country | US
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Telephone | 909-867-9083
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Fax | 909-867-9086
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Authorized Official
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Title or Position | OWNER
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Name | GEVORK ADZHEMYAN
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Credential |
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Telephone | 909-867-9083
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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 | PHY44340
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License Number State | CA
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