MEDICARE: CBC PROFESSIONAL PHARMACY INC

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	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0598649	OTHER		BABO#

General Provider Information

NPI Number	:	1699777177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CBC PROFESSIONAL PHARMACY INC

Provider Business Mailing Address
First Line	:	2095 W ARROW RTE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-4210
Country	:	US
Telephone Number	:	909-982-4843
Fax Number	:	909-982-4967

Provider Business Practice Location Address
First Line	:	1818 N ORANGE GROVE AVE
Second Line	:	SUITE 100
City	:	POMONA
State	:	CA
Zip	:	91767-3028
Country	:	US
Telephone Number	:	909-623-0623
Fax Number	:	909-622-1732

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARLA L FREED
Credential	:
Telephone Number	:	909-982-4843

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	08/22/2020

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Directions to “CBC PROFESSIONAL PHARMACY INC ” Practice Location

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