MEDICARE: INJOY RX, LLC

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	3336C0003X	Community/Retail Pharmacy	PHY55773	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2153500	OTHER		PK

General Provider Information

NPI Number	:	1114307923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INJOY RX, LLC

Provider Business Mailing Address
First Line	:	14676 PIPELINE AVE
Second Line	:	STE M
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1909
Country	:	US
Telephone Number	:	909-597-9500
Fax Number	:	909-597-0189

Provider Business Practice Location Address
First Line	:	14676 PIPELINE AVE STE M
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1918
Country	:	US
Telephone Number	:	909-597-9500
Fax Number	:	909-597-0189

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL LEE
Credential	:
Telephone Number	:	909-597-9500

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	11/02/2017

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