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General NPI Number Information
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NPI Number | 1043445208
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Entity Type | Organization
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Legal Business Name | SAI BEAR CREEK PHARMACY LLC
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 24046 CLINTON KEITH RD SUITE 107
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City | WILDOMAR
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State | CA
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Zip | 92595
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Country | US
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Telephone | 951-677-4880
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Fax | 951-698-4392
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Provider Business Mailing Address
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Address Line | 24046 CLINTON KEITH RD SUITE 107
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City | WILDOMAR
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State | CA
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Zip | 92595
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Country | US
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Telephone | 951-677-4880
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Fax | 951-698-4392
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. SAISATISH GUNDA
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Credential |
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Telephone | 951-677-4880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 50678
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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