MEDICARE: SAFA PHARMACY CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5632751	OTHER	CA	NCPDP #

General Provider Information

NPI Number	:	1114170172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFA PHARMACY CORPORATION

Provider Business Mailing Address
First Line	:	1520 N MOUNTAIN AVE STE 125
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-1132
Country	:	US
Telephone Number	:	909-391-3542
Fax Number	:	909-391-6916

Provider Business Practice Location Address
First Line	:	1520 N MOUNTAIN AVE STE 125
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-1132
Country	:	US
Telephone Number	:	909-391-3542
Fax Number	:	909-391-6916

Authorized Official
Title or Position	:	OWNER
Name	:	EHAB TAWFIK
Credential	:
Telephone Number	:	909-391-3542

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	03/07/2023

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