Provider Demographics
NPI:1295051779
Name:WESTERN UNIVERSITY OF HEALTH SCIENCES
Entity type:Organization
Organization Name:WESTERN UNIVERSITY OF HEALTH SCIENCES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PREETI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:909-706-3765
Mailing Address - Street 1:795 E 2ND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-706-3730
Mailing Address - Fax:909-706-3731
Practice Address - Street 1:795 E 2ND ST STE 1
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3730
Practice Address - Fax:909-706-3731
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN UNIVERSITY OF HEALTH SCIENCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-09
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502593336C0002X, 3336C0003X, 333600000X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy