Provider Demographics
NPI:1447576699
Name:JP PHARMACY INC
Entity Type:Organization
Organization Name:JP PHARMACY INC
Other - Org Name:JP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:858-271-0014
Mailing Address - Street 1:9188 MIRA MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4804
Mailing Address - Country:US
Mailing Address - Phone:858-271-0014
Mailing Address - Fax:858-271-0042
Practice Address - Street 1:9188 MIRA MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4804
Practice Address - Country:US
Practice Address - Phone:858-382-7279
Practice Address - Fax:858-750-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA592473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447576699Medicaid