=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164943627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UTTARA RX INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2017
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16928 VENTURA BLVD
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-788-0635
-----------------------------------------------------
Fax | 818-386-2688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16928 VENTURA BLVD
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-788-0635
-----------------------------------------------------
Fax | 818-386-2688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SEEMA PATEL
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 818-389-6381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY55743
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------