Healthcare Provider Details

I. General information

NPI: 1629359856
Provider Name (Legal Business Name): RSS PHARMACY ASSOCIATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E 3RD ST
CORONA CA
92879-1438
US

IV. Provider business mailing address

223 E 3RD ST
CORONA CA
92879-1438
US

V. Phone/Fax

Practice location:
  • Phone: 951-444-7057
  • Fax: 951-444-7056
Mailing address:
  • Phone: 951-444-7057
  • Fax: 951-444-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50781
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAMIR PATEL
Title or Position: OWNER
Credential:
Phone: 951-444-7057