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1518657535 NPI number — EL MIRADOR MEDICAL PLAZA PHARMACY INC

NPI Number: 1518657535
Health Care Provider/Practitioner: EL MIRADOR MEDICAL PLAZA PHARMACY INC

Information about “1518657535” NPI (EL MIRADOR MEDICAL PLAZA PHARMACY INC) exists in 1518657535 in HTML format HTML  |  1518657535 in plain Text format TXT  |  1518657535 in PDF (Portable Document Format) PDF  |  1518657535 in an XML format XML  formats.

NPI Number : 1518657535 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1518657535",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "EL MIRADOR MEDICAL PLAZA PHARMACY INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3975 JACKSON ST STE 109",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIVERSIDE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92503-3946",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "951-637-0180",
    "MailingAddressFaxNumber": "951-637-0183",
    "FirstLinePracticeLocationAddress": "7117 BROCKTON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIVERSIDE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92506-2658",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-899-8199",
    "PracticeLocationAddressFaxNumber": "951-899-8198",
    "EnumerationDate": "05/12/2023",
    "LastUpdateDate": "02/13/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "UPADHYAYULA",
    "AuthorizedOfficialFirstName": "RAMESH",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT/CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RPH",
    "AuthorizedOfficialTelephoneNumber": "760-323-1001",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "3336C0002X",
          "TaxonomyName": "Clinic Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336L0003X",
          "TaxonomyName": "Long Term Care Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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