Healthcare Provider Details

I. General information

NPI: 1326476631
Provider Name (Legal Business Name): SKY PHARMA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10237 MAGNOLIA AVE
RIVERSIDE CA
92503-3440
US

IV. Provider business mailing address

10237 MAGNOLIA AVE
RIVERSIDE CA
92503-3440
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-9277
  • Fax: 951-509-9288
Mailing address:
  • Phone: 951-509-9277
  • Fax: 951-509-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number51646
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number51646
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number99865
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number51646
License Number StateCA

VIII. Authorized Official

Name: MICHAEL TADROS
Title or Position: PHARMACIST IN CHARGE /CEO
Credential: RPH
Phone: 951-509-9277