Provider Demographics
NPI:1235431768
Name:ABIFADEL PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:ABIFADEL PHARMACY SERVICES INC
Other - Org Name:T.H.E. PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAJY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIFADEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-946-6411
Mailing Address - Street 1:360 E 7TH ST STE F
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6701
Mailing Address - Country:US
Mailing Address - Phone:909-946-6411
Mailing Address - Fax:909-946-6441
Practice Address - Street 1:360 E 7TH ST STE F
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6701
Practice Address - Country:US
Practice Address - Phone:909-946-6411
Practice Address - Fax:909-946-6441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-05
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY504753336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127951OtherPK
CA1235431768Medicaid