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General NPI Number Information
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NPI Number | 1134038953
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Entity Type | Organization
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Legal Business Name | IMPERIAL BEACH PHARMACY LLC
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Dates
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Enumeration Date | 09/07/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 1530 PALM AVE
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City | SAN DIEGO
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State | CA
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Zip | 92154-1016
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Country | US
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Telephone | 619-343-0095
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Fax | 619-830-4590
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Provider Business Mailing Address
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Address Line | 1530 PALM AVE
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City | SAN DIEGO
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State | CA
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Zip | 92154-1016
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Country | US
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Telephone | 619-343-0095
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Fax | 619-830-4590
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Authorized Official
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Title or Position | OWNER
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Name | PRASHANT AMRUTLAL KOYANI
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Credential |
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Telephone | 619-343-0095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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