Provider Demographics
NPI:1477197440
Name:MACH, VINCENT (PHARMD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:MACH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W VALLEY BLVD # 1007
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3338
Mailing Address - Country:US
Mailing Address - Phone:626-466-2168
Mailing Address - Fax:
Practice Address - Street 1:10801 6TH ST
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5977
Practice Address - Country:US
Practice Address - Phone:909-890-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-03
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist