Provider Demographics
NPI:1568495976
Name:ARROWMED LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:ARROWMED LIMITED PARTNERSHIP
Other - Org Name:ARROWMED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERLINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHOMMALAYHANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-476-1992
Mailing Address - Street 1:9057 ARROW RTE
Mailing Address - Street 2:170 C
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9057 ARROW RTE
Practice Address - Street 2:170 C
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4452
Practice Address - Country:US
Practice Address - Phone:909-476-1992
Practice Address - Fax:909-476-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
CAPHY471753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5617533OtherOTHER ID NUMBER