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General NPI Number Information
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NPI Number | 1518657535
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Entity Type | Organization
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Legal Business Name | EL MIRADOR MEDICAL PLAZA PHARMACY INC
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 7117 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2658
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Country | US
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Telephone | 951-899-8199
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Fax | 951-899-8198
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Provider Business Mailing Address
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Address Line | 3975 JACKSON ST STE 109
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City | RIVERSIDE
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State | CA
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Zip | 92503-3946
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Country | US
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Telephone | 951-637-0180
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Fax | 951-637-0183
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | RAMESH UPADHYAYULA
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Credential | RPH
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Telephone | 760-323-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic 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 | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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