Healthcare Provider Details

I. General information

NPI: 1164304127
Provider Name (Legal Business Name): SD HEALTHCARE RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 CHILDRENS WAY STE 108
SAN DIEGO CA
92123-4226
US

IV. Provider business mailing address

3030 CHILDRENS WAY STE 108
SAN DIEGO CA
92123-4226
US

V. Phone/Fax

Practice location:
  • Phone: 858-313-0200
  • Fax: 858-313-0202
Mailing address:
  • Phone: 858-313-0200
  • Fax: 858-313-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NIXIT D VADDORIYA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 858-313-0200