=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275268716
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | U.D. ALPHA PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2022
-----------------------------------------------------
Last Update Date | 08/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 S BEACH BLVD STE AB
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92804-1812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-821-8959
-----------------------------------------------------
Fax | 714-821-4261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 S BEACH BLVD STE AB
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92804-1812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-821-8959
-----------------------------------------------------
Fax | 714-821-4261
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/ PHARMACIST IN CHARGE
-----------------------------------------------------
Name | MR. DINESH PATEL
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 714-821-8959
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------