Healthcare Provider Details

I. General information

NPI: 1770349516
Provider Name (Legal Business Name): WHITECROSS APOTHECARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6780 INDIANA AVE STE 145
RIVERSIDE CA
92506-4270
US

IV. Provider business mailing address

6780 INDIANA AVE STE 145
RIVERSIDE CA
92506-4270
US

V. Phone/Fax

Practice location:
  • Phone: 951-777-2881
  • Fax: 951-777-2881
Mailing address:
  • Phone: 951-777-2881
  • Fax:

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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VENUMADHAV CHALUVADI
Title or Position: MEMBER
Credential:
Phone: 973-885-2793