Provider Demographics
NPI:1710100359
Name:BEAR CREEK PHARMACY LTC
Entity Type:Organization
Organization Name:BEAR CREEK PHARMACY LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:951-677-5220
Mailing Address - Street 1:36243 INLAND VALLEY DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595
Mailing Address - Country:US
Mailing Address - Phone:951-677-5220
Mailing Address - Fax:951-677-1149
Practice Address - Street 1:36243 INLAND VALLEY DRIVE
Practice Address - Street 2:SUITE 150
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595
Practice Address - Country:US
Practice Address - Phone:951-677-5220
Practice Address - Fax:951-677-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY47553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty