Provider Demographics
NPI:1457724627
Name:ONE STOP PHARMACARE INC
Entity Type:Organization
Organization Name:ONE STOP PHARMACARE INC
Other - Org Name:CANARY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VANSON
Authorized Official - Middle Name:T
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:909-445-0805
Mailing Address - Street 1:4950 SAN BERNARDINO ST
Mailing Address - Street 2:101A
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2328
Mailing Address - Country:US
Mailing Address - Phone:909-445-0805
Mailing Address - Fax:909-621-5732
Practice Address - Street 1:4950 SAN BERNARDINO ST
Practice Address - Street 2:101A
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2328
Practice Address - Country:US
Practice Address - Phone:909-445-0805
Practice Address - Fax:909-621-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457724627Medicaid