MEDICARE: RESOURCE 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	50891	CA

General Provider Information

NPI Number	:	1770848566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESOURCE PHARMACY, INC

Provider Business Mailing Address
First Line	:	1535 S D ST
Second Line	:	SUITE 230
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3253
Country	:	US
Telephone Number	:	909-884-5555
Fax Number	:	909-884-5454

Provider Business Practice Location Address
First Line	:	1535 S D ST
Second Line	:	SUITE 230
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3253
Country	:	US
Telephone Number	:	909-884-5555
Fax Number	:	909-884-5454

Authorized Official
Title or Position	:	MANAGER
Name	:	SAM YEM
Credential	:
Telephone Number	:	909-884-5555

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	07/09/2012

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