Provider Demographics
NPI:1801218029
Name:SJC MANAGEMENT AND CONSULTING CORP
Entity Type:Organization
Organization Name:SJC MANAGEMENT AND CONSULTING CORP
Other - Org Name:PHILLIPS RANCH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:909-766-8330
Mailing Address - Street 1:3040 & 3042 W TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-6816
Mailing Address - Country:US
Mailing Address - Phone:909-766-8330
Mailing Address - Fax:909-766-8332
Practice Address - Street 1:3040 & 3042 W TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-6816
Practice Address - Country:US
Practice Address - Phone:909-766-8330
Practice Address - Fax:909-766-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 51705333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 51705OtherCALIFORNIA STATE BOARD OF PHARMACY