Provider Demographics
NPI:1952815409
Name:CAL2000 PHARMACY INC
Entity Type:Organization
Organization Name:CAL2000 PHARMACY INC
Other - Org Name:VILLA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-546-1000
Mailing Address - Street 1:326 E HOLT BLVD
Mailing Address - Street 2:STE E
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-1609
Mailing Address - Country:US
Mailing Address - Phone:909-254-6911
Mailing Address - Fax:909-285-9928
Practice Address - Street 1:326 E HOLT BLVD STE E
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-1635
Practice Address - Country:US
Practice Address - Phone:909-254-6911
Practice Address - Fax:909-285-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA558833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2173969OtherPK