Provider Demographics
NPI:1114031002
Name:PHARM MED SERVICES
Entity Type:Organization
Organization Name:PHARM MED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:916-487-4488
Mailing Address - Street 1:2129 HACIENDA WAY
Mailing Address - Street 2:STE J
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-0362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2129 HACIENDA WAY
Practice Address - Street 2:STE J
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0362
Practice Address - Country:US
Practice Address - Phone:916-487-4488
Practice Address - Fax:916-487-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY431413336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0572900OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA431410Medicaid