Healthcare Provider Details

I. General information

NPI: 1073321337
Provider Name (Legal Business Name): EADARA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 MAGNOLIA AVE STE C&F
RIVERSIDE CA
92504-3864
US

IV. Provider business mailing address

7130 MAGNOLIA AVE STE C&F
RIVERSIDE CA
92504-3864
US

V. Phone/Fax

Practice location:
  • Phone: 951-637-3399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHANDRASEKHAR EADARA
Title or Position: CEO/CFO/SEC./DIR.
Credential:
Phone: 361-813-4639