Healthcare Provider Details

I. General information

NPI: 1629613260
Provider Name (Legal Business Name): EMPIRE INFUSION PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 CHICAGO AVE UNIT A3
RIVERSIDE CA
92507-2315
US

IV. Provider business mailing address

2025 CHICAGO AVE UNIT A3
RIVERSIDE CA
92507-2315
US

V. Phone/Fax

Practice location:
  • Phone: 951-777-1363
  • Fax: 951-444-9577
Mailing address:
  • Phone: 951-777-1363
  • Fax: 951-444-9577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MANUEL MONTOYA
Title or Position: OWNER
Credential:
Phone: 951-777-1363