Healthcare Provider Details

I. General information

NPI: 1700322013
Provider Name (Legal Business Name): ENKELI PHARMACY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2392 UNIVERSITY AVE
RIVERSIDE CA
92507-4266
US

IV. Provider business mailing address

2392 UNIVERSITY AVE
RIVERSIDE CA
92507-4266
US

V. Phone/Fax

Practice location:
  • Phone: 951-289-9916
  • Fax: 888-757-3815
Mailing address:
  • Phone: 951-289-9916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number54663
License Number StateCA

VIII. Authorized Official

Name: KEJING GUO
Title or Position: CEO
Credential:
Phone: 951-289-9916