Healthcare Provider Details

I. General information

NPI: 1720356264
Provider Name (Legal Business Name): ROCHESTER ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 BUSINESS CENTER DR SUITE 245
IRVINE CA
92612-1119
US

IV. Provider business mailing address

2081 BUSINESS CENTER DR SUITE 245
IRVINE CA
92612-1119
US

V. Phone/Fax

Practice location:
  • Phone: 800-986-5164
  • Fax: 800-986-5164
Mailing address:
  • Phone: 800-986-5164
  • Fax: 800-986-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberC0867846
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberC0867846
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberC0867846
License Number StateCA

VIII. Authorized Official

Name: DR. HAROLD CARTER
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D
Phone: 800-986-5164