Healthcare Provider Details

I. General information

NPI: 1134595861
Provider Name (Legal Business Name): X-PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 S SUNRISE WAY
PALM SPRINGS CA
92262-6737
US

IV. Provider business mailing address

174 S SUNRISE WAY
PALM SPRINGS CA
92262-6737
US

V. Phone/Fax

Practice location:
  • Phone: 760-778-8870
  • Fax: 760-778-8850
Mailing address:
  • Phone: 760-778-8870
  • Fax: 760-778-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY55721
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL EDWARD MILAD TADROS
Title or Position: CEO
Credential:
Phone: 626-234-3186