Provider Demographics
NPI:1801170121
Name:ARLINGTON INPATIENT TREATMENT FACILITY PHARMACY
Entity type:Organization
Organization Name:ARLINGTON INPATIENT TREATMENT FACILITY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:951-358-4958
Mailing Address - Street 1:9990 COUNTY FARM ROAD
Mailing Address - Street 2:SUITE #2 / DEPT. OF PHARMACY SERVICE - C. SCHAFFLER
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-358-4746
Mailing Address - Fax:951-358-4626
Practice Address - Street 1:9990 COUNTY FARM RD
Practice Address - Street 2:SUITE #2 / DEPT. OF PHARMACY SERVICE - C. SCHAFFLER
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3542
Practice Address - Country:US
Practice Address - Phone:951-358-4746
Practice Address - Fax:951-358-4626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERSIDE COUNTY REGIONAL MEDICAL CENTER PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000195282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-0292OtherMEDICARE
CAHSC30292WMedicaid
CAHPE 35875OtherCA-LICENSE #
CA0577734OtherNCPDP/NABP
CAPHB 435930OtherMEDI - CAL PROVIDER #