Healthcare Provider Details

I. General information

NPI: 1295361632
Provider Name (Legal Business Name): LLAXMI RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 S RIVERSIDE AVE
RIALTO CA
92376-6523
US

IV. Provider business mailing address

436 S RIVERSIDE AVE
RIALTO CA
92376-6523
US

V. Phone/Fax

Practice location:
  • Phone: 909-961-2288
  • Fax: 909-301-0110
Mailing address:
  • Phone: 909-961-2288
  • Fax: 909-301-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DARSHAN S BHAKTA
Title or Position: OWNER/PIC
Credential:
Phone: 909-961-2288