Healthcare Provider Details

I. General information

NPI: 1104909258
Provider Name (Legal Business Name): RANCHO DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17798 WIKA RD
APPLE VALLEY CA
92307-1219
US

IV. Provider business mailing address

17798 WIKA RD
APPLE VALLEY CA
92307-1219
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-4900
  • Fax: 760-242-8962
Mailing address:
  • Phone: 760-242-4900
  • Fax: 760-242-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY22609
License Number StateCA

VIII. Authorized Official

Name: MR. GOPAL SOJITRA
Title or Position: PHARMACIST/CEO/PHARMACIST
Credential: PHARM D
Phone: 760-242-4900