Provider Demographics
NPI:1134814593
Name:ANGELIC RX PHARMACY, INC.
Entity type:Organization
Organization Name:ANGELIC RX PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VP/DIR
Authorized Official - Prefix:
Authorized Official - First Name:SHIENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-256-3773
Mailing Address - Street 1:600 N MOUNTAIN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4359
Mailing Address - Country:US
Mailing Address - Phone:909-256-3663
Mailing Address - Fax:909-377-5025
Practice Address - Street 1:600 N MOUNTAIN AVE STE E
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4359
Practice Address - Country:US
Practice Address - Phone:909-256-3663
Practice Address - Fax:909-377-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy