Healthcare Provider Details

I. General information

NPI: 1609201706
Provider Name (Legal Business Name): ESCONDIDO PHARMACY AND DME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E VALLEY PKWY
ESCONDIDO CA
92025-3428
US

IV. Provider business mailing address

909 E VALLEY PKWY
ESCONDIDO CA
92025-3428
US

V. Phone/Fax

Practice location:
  • Phone: 760-741-9804
  • Fax: 760-480-6317
Mailing address:
  • Phone: 760-741-9804
  • Fax: 760-480-6317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. NAMVAR TAGHIPOUR
Title or Position: PRESIDENT
Credential: RPH
Phone: 760-741-9804