Provider Demographics
NPI:1902186224
Name:CAMBRIDGE PHARMACY INC
Entity Type:Organization
Organization Name:CAMBRIDGE PHARMACY INC
Other - Org Name:CAMBRIDGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEVORK
Authorized Official - Middle Name:
Authorized Official - Last Name:ADZHEMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-867-9083
Mailing Address - Street 1:14101 MAIN ST
Mailing Address - Street 2:STE 103
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-8098
Mailing Address - Country:US
Mailing Address - Phone:909-867-9083
Mailing Address - Fax:909-867-9086
Practice Address - Street 1:14101 MAIN ST
Practice Address - Street 2:STE 103
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-8098
Practice Address - Country:US
Practice Address - Phone:909-867-9083
Practice Address - Fax:909-867-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY443403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy