Provider Demographics
NPI:1407926215
Name:PHARMACY SERVICE INC
Entity Type:Organization
Organization Name:PHARMACY SERVICE INC
Other - Org Name:BEEMANS LAKE ARROWHEAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-337-0747
Mailing Address - Street 1:399 E HIGHLAND AVE
Mailing Address - Street 2:STE #103
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3808
Mailing Address - Country:US
Mailing Address - Phone:909-886-6851
Mailing Address - Fax:909-886-9534
Practice Address - Street 1:29099 HOSPITAL RD
Practice Address - Street 2:STE 101
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352
Practice Address - Country:US
Practice Address - Phone:909-337-0747
Practice Address - Fax:909-337-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY522533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149645OtherPK
CAPHA435330Medicaid