MEDICARE: CLAREMONT 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
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY54251	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2159777	OTHER		PK

General Provider Information

NPI Number	:	1922479716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAREMONT PHARMACY INC

Provider Business Mailing Address
First Line	:	358 S INDIAN HILL BLVD
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-5223
Country	:	US
Telephone Number	:	714-725-1346
Fax Number	:	909-929-7229

Provider Business Practice Location Address
First Line	:	358 S INDIAN HILL BLVD
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-5223
Country	:	US
Telephone Number	:	909-929-7228
Fax Number	:	909-929-7229

Authorized Official
Title or Position	:	PIC PRESIDENT/CEO OWNER
Name	:	NIKKI HO
Credential	:	PHARM.D
Telephone Number	:	714-725-1346

Provider Enumeration Date	:	10/19/2015
Last Update Date	:	03/06/2017

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