Provider Demographics
NPI:1912415118
Name:APPLE PHARMACY INC
Entity Type:Organization
Organization Name:APPLE PHARMACY INC
Other - Org Name:ABC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:909-546-1000
Mailing Address - Street 1:5050 SAN BERNARDINO ST STE 110
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5050 SAN BERNARDINO ST STE 110
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2326
Practice Address - Country:US
Practice Address - Phone:909-264-1331
Practice Address - Fax:909-330-0933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLE PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55887333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55883OtherPHARMACY LICENSE