=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922467901
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CNC PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2016
-----------------------------------------------------
Last Update Date | 03/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 W ROWLAND ST
-----------------------------------------------------
City | COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91723-2943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-966-9888
-----------------------------------------------------
Fax | 626-966-1879
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 660008
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91066-0008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-966-9888
-----------------------------------------------------
Fax | 626-966-1879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RACHEL CHHEK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-241-0926
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY53895
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------