Provider Demographics
NPI:1952490286
Name:JANET PHARMACY ENTERPRISES INC
Entity Type:Organization
Organization Name:JANET PHARMACY ENTERPRISES INC
Other - Org Name:YORBA LINDA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:JANET
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-528-3610
Mailing Address - Street 1:5596 E LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2108
Mailing Address - Country:US
Mailing Address - Phone:714-993-1458
Mailing Address - Fax:714-917-2201
Practice Address - Street 1:5596 E LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2108
Practice Address - Country:US
Practice Address - Phone:714-993-1458
Practice Address - Fax:714-917-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY44045333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA440450Medicaid
CA4789640002Medicare NSC