Provider Demographics
NPI:1750470720
Name:JANET PHARMACY ENTERPRISES INC
Entity Type:Organization
Organization Name:JANET PHARMACY ENTERPRISES INC
Other - Org Name:LINDA VISTA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:JANET
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-528-3610
Mailing Address - Street 1:4300 ROSE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2026
Mailing Address - Country:US
Mailing Address - Phone:714-528-3610
Mailing Address - Fax:714-528-0701
Practice Address - Street 1:4300 ROSE DR
Practice Address - Street 2:SUITE D
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2026
Practice Address - Country:US
Practice Address - Phone:714-528-3610
Practice Address - Fax:714-528-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY37865333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4789640001Medicare NSC