Healthcare Provider Details

I. General information

NPI: 1861297178
Provider Name (Legal Business Name): EL MIRADOR MEDICAL PLAZA PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21634 RETREAT PKWY STE 101
TEMESCAL VALLEY CA
92883-6100
US

IV. Provider business mailing address

1180 N INDIAN CANYON DR STE E140
PALM SPRINGS CA
92262-4883
US

V. Phone/Fax

Practice location:
  • Phone: 951-963-3330
  • Fax: 951-963-3331
Mailing address:
  • Phone: 760-323-1001
  • Fax: 760-323-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. RAMESH UPADHYAYULA
Title or Position: PRESIDENT
Credential: RPH
Phone: 760-323-1001