Provider Demographics
NPI:1255342838
Name:CHJ PHARMACARE INC
Entity type:Organization
Organization Name:CHJ PHARMACARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-379-3080
Mailing Address - Street 1:12841 WESTERN AVE
Mailing Address - Street 2:UNIT # D
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-4025
Mailing Address - Country:US
Mailing Address - Phone:714-379-3080
Mailing Address - Fax:714-379-3082
Practice Address - Street 1:12841 WESTERN AVE STE D
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4025
Practice Address - Country:US
Practice Address - Phone:714-379-3080
Practice Address - Fax:714-379-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336S0011X, 333600000X
CAPHY453343336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1995847OtherPK
CAPHA453340Medicaid