Provider Demographics
NPI:1790030773
Name:SEVENTH DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:SEVENTH DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER, INC.
Other - Org Name:LOMA LINDA UNIVERSITY - HIGHLAND SPRINGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HEINRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-558-4308
Mailing Address - Street 1:81 HIGHLAND SPRINGS AVE
Mailing Address - Street 2:SUITE 90
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-3170
Mailing Address - Country:US
Mailing Address - Phone:951-849-3378
Mailing Address - Fax:951-849-3332
Practice Address - Street 1:81 HIGHLAND SPRINGS AVE
Practice Address - Street 2:SUITE 90
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3170
Practice Address - Country:US
Practice Address - Phone:951-849-3378
Practice Address - Fax:951-849-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY509333336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5644720OtherNCPDP PROVIDER IDENTIFICATION NUMBER