Provider Demographics
NPI:1346381076
Name:HOSPICARE PHARMACY INLAND EMPIRE
Entity Type:Organization
Organization Name:HOSPICARE PHARMACY INLAND EMPIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-736-5828
Mailing Address - Street 1:3000 N HOLLYWOOD WAY
Mailing Address - Street 2:STE 103
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1026
Mailing Address - Country:US
Mailing Address - Phone:818-736-5828
Mailing Address - Fax:818-736-5838
Practice Address - Street 1:425 W RIDER ST
Practice Address - Street 2:SUITE B2
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-3230
Practice Address - Country:US
Practice Address - Phone:951-943-6303
Practice Address - Fax:951-943-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346381076Medicaid