Provider Demographics
NPI:1003811134
Name:IJJ GROUP, INC
Entity Type:Organization
Organization Name:IJJ GROUP, INC
Other - Org Name:PALMDALE MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:HSIAO
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:661-267-2638
Mailing Address - Street 1:540 W PALMDALE BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4232
Mailing Address - Country:US
Mailing Address - Phone:661-267-2638
Mailing Address - Fax:661-267-0813
Practice Address - Street 1:540 W PALMDALE BLVD
Practice Address - Street 2:STE A
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4232
Practice Address - Country:US
Practice Address - Phone:661-267-2638
Practice Address - Fax:661-267-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA466440Medicaid
CAPHA466440Medicaid