Provider Demographics
NPI:1871794164
Name:INLAND COMPOUNDING PHARMACY, INC.
Entity type:Organization
Organization Name:INLAND COMPOUNDING PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYLENE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MOTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:909-478-3842
Mailing Address - Street 1:24747 REDLANDS BLVD
Mailing Address - Street 2:SUITE F.
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4026
Mailing Address - Country:US
Mailing Address - Phone:909-478-3248
Mailing Address - Fax:909-478-3853
Practice Address - Street 1:24747 REDLANDS BLVD
Practice Address - Street 2:SUITE F.
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4026
Practice Address - Country:US
Practice Address - Phone:909-478-3248
Practice Address - Fax:909-478-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY457583336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy