Provider Demographics
NPI:1376639195
Name:CALIFORNIA PHRM SERV INC
Entity Type:Organization
Organization Name:CALIFORNIA PHRM SERV INC
Other - Org Name:ARROW MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-339-6141
Mailing Address - Street 1:453 E ARROW HWY
Mailing Address - Street 2:STE E
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-5612
Mailing Address - Country:US
Mailing Address - Phone:626-339-6141
Mailing Address - Fax:626-858-0439
Practice Address - Street 1:453 E ARROW HWY
Practice Address - Street 2:STE E
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-5612
Practice Address - Country:US
Practice Address - Phone:626-339-6141
Practice Address - Fax:626-858-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X, 3336S0011X
CAPHY475933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2094123OtherPK
CAPHA475930Medicaid
CAPHA475930Medicaid