Healthcare Provider Details

I. General information

NPI: 1225374564
Provider Name (Legal Business Name): JURUPA VALLEY PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7830 LIMONITE AVE
JURUPA VALLEY CA
92509-5360
US

IV. Provider business mailing address

7830 LIMONITE AVE
JURUPA VALLEY CA
92509-5360
US

V. Phone/Fax

Practice location:
  • Phone: 951-332-2235
  • Fax: 951-332-2236
Mailing address:
  • Phone: 951-332-2235
  • Fax: 951-332-2236

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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANTOSH PATEL
Title or Position: OWNER
Credential:
Phone: 951-332-2235