Healthcare Provider Details

I. General information

NPI: 1861504854
Provider Name (Legal Business Name): EL MIRADOR MEDICAL PLAZA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/19/2025
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR STE E140 SUITE E140
PALM SPRINGS CA
92262-4883
US

IV. Provider business mailing address

1180 N INDIAN CANYON DR STE E140 SUITE E140
PALM SPRINGS CA
92262-4883
US

V. Phone/Fax

Practice location:
  • Phone: 760-323-1001
  • Fax: 760-323-1144
Mailing address:
  • Phone: 760-323-1001
  • Fax: 760-323-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY46465
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAMESH UPADHYAYULA
Title or Position: PRESIDENT
Credential:
Phone: 760-323-1001