Active NPI
JC Max Pharmacy Inc
- Community/Retail Pharmacy
- Upland, CA
National Provider Identifier
1528112174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY39350
- Legal business name
- JC MAX PHARMACY INC
- Doing business as
- ABC PHARMACY
- Practice address
- 954 W Foothill Blvd
Suite #6D
Upland, CA 91786-3782 - Phone
- (909) 946-5512
- Fax
- (909) 946-6512
- NPI assigned
- Jan 22, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tony Chan, PHARMD
- Title
- Pharmacist
- Phone
- (909) 946-5512
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PHY39350 | CA | Primary |
Addresses
Primary practice location
954 W Foothill Blvd
Suite #6D
Upland, CA 91786-3782
Mailing address
954 W Foothill Blvd
Suite #6D
Upland, CA 91786-3782
Phone (909) 946-5512
Other names 1
- ABC PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210204001740 | CA | Part B Supplier - Pharmacy | 8527472497 |
1 other NPI on this enrollment Practice locations: Rialto, CA; Upland, CA |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1607472000000",
"number": "1528112174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "954 W FOOTHILL BLVD",
"address_2": "SUITE #6D",
"city": "UPLAND",
"state": "CA",
"postal_code": "917863782",
"telephone_number": "909-946-5512",
"fax_number": "909-946-6512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "954 W FOOTHILL BLVD",
"address_2": "SUITE #6D",
"city": "UPLAND",
"state": "CA",
"postal_code": "917863782",
"telephone_number": "909-946-5512",
"fax_number": "909-946-6512"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JC MAX PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-22",
"last_updated": "2020-12-09",
"certification_date": "2020-12-09",
"status": "A",
"authorized_official_last_name": "CHAN",
"authorized_official_first_name": "TONY",
"authorized_official_title_or_position": "PHARMACIST",
"authorized_official_telephone_number": "909-946-5512",
"authorized_official_credential": "PHARMD"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CA",
"license": "PHY39350",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "ABC PHARMACY",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "ABC PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.