Provider Demographics
NPI:1679628085
Name:ONTARIO PHARMACY INC.
Entity Type:Organization
Organization Name:ONTARIO PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:909-986-8161
Mailing Address - Street 1:666 E E ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4228
Mailing Address - Country:US
Mailing Address - Phone:909-986-8161
Mailing Address - Fax:909-986-0915
Practice Address - Street 1:666 E E ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4228
Practice Address - Country:US
Practice Address - Phone:909-986-8161
Practice Address - Fax:909-986-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA223550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5536240001Medicare ID - Type UnspecifiedMEDICARE PART B