Provider Demographics
NPI:1740679901
Name:CHINO HILLS MED-PLAZA PHARMACY INC
Entity type:Organization
Organization Name:CHINO HILLS MED-PLAZA PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:
Authorized Official - First Name:RAANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-465-6562
Mailing Address - Street 1:3110 CHINO AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1211
Mailing Address - Country:US
Mailing Address - Phone:909-465-6562
Mailing Address - Fax:909-465-9260
Practice Address - Street 1:3110 CHINO AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1294
Practice Address - Country:US
Practice Address - Phone:909-465-6562
Practice Address - Fax:909-465-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA525343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149787OtherPK