Healthcare Provider Details

I. General information

NPI: 1164503850
Provider Name (Legal Business Name): EL TEJON HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BRUNDAGE LN
BAKERSFIELD CA
93304-2430
US

IV. Provider business mailing address

PO BOX 9037
BAKERSFIELD CA
93389-9037
US

V. Phone/Fax

Practice location:
  • Phone: 661-325-7284
  • Fax: 661-327-5144
Mailing address:
  • Phone: 661-325-7284
  • Fax: 661-327-5144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHEELA BHAVINKUMAR MEGHAPARA
Title or Position: PIC
Credential: RPH
Phone: 661-325-7284