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General NPI Number Information
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NPI Number | 1982615514
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Entity Type | Organization
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Legal Business Name | FOOTHILL PHARMACY
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 02/22/2011
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Provider Practice Location Address
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Address Line | 1850 N RIVERSIDE AVE SUITE 170
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City | RIALTO
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State | CA
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Zip | 92376-8071
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Country | US
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Telephone | 909-874-2385
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Fax | 909-874-2428
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Provider Business Mailing Address
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Address Line | 1850 N RIVERSIDE AVE SUITE 170
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City | RIALTO
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State | CA
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Zip | 92376-8071
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Country | US
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Telephone | 909-874-2385
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Fax | 909-874-2428
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Authorized Official
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Title or Position | OWNER AND PHARMACIST
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Name | ROBERT OLIVA
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Credential |
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Telephone | 909-874-2385
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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 | 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 #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY45239
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License Number State | CA
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