Healthcare Provider Details

I. General information

NPI: 1699550400
Provider Name (Legal Business Name): PARADISE PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 4TH AVE STE 150
SAN DIEGO CA
92103-7193
US

IV. Provider business mailing address

8881 FLETCHER PKWY STE 103
LA MESA CA
91942-3130
US

V. Phone/Fax

Practice location:
  • Phone: 619-839-0455
  • Fax:
Mailing address:
  • Phone: 858-560-1979
  • Fax: 858-560-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROLANFRANCIS ARELLANO LEGASPI
Title or Position: CEO/DIRECTOR
Credential: PHARM.D.
Phone: 858-560-1911