Provider Demographics
NPI:1699227983
Name:LANDMARK PHARMA INC
Entity Type:Organization
Organization Name:LANDMARK PHARMA INC
Other - Org Name:ALTA CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, AO
Authorized Official - Prefix:
Authorized Official - First Name:JINESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-270-7432
Mailing Address - Street 1:1113 ALTA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2804
Mailing Address - Country:US
Mailing Address - Phone:909-360-8352
Mailing Address - Fax:909-360-8372
Practice Address - Street 1:1113 ALTA AVE STE 100
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2804
Practice Address - Country:US
Practice Address - Phone:909-360-8352
Practice Address - Fax:909-360-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X, 3336C0004X, 3336L0003X, 3336S0011X
CA553963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166065OtherPK