Provider Demographics
NPI:1972772804
Name:ARROWMED LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:ARROWMED LIMITED PARTNERSHIP
Other - Org Name:ARROWMED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:BERLINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHOMMALAYVANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY TECH
Authorized Official - Phone:909-466-6701
Mailing Address - Street 1:9057 ARROW ROUTE
Mailing Address - Street 2:SUITE 170C
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4452
Mailing Address - Country:US
Mailing Address - Phone:909-476-1992
Mailing Address - Fax:909-476-7747
Practice Address - Street 1:9057 ARROW ROUTE
Practice Address - Street 2:SUITE 170C
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4452
Practice Address - Country:US
Practice Address - Phone:909-476-1992
Practice Address - Fax:909-476-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY47175332BX2000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5822470001Medicare NSC
CA1386746196Medicare NSC
CA5822470001Medicare PIN