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General NPI Number Information
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NPI Number | 1548080179
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Entity Type | Organization
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Legal Business Name | RELIANCE IMPERIAL PHARMACY LLC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1692 S 4TH ST STE F
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City | EL CENTRO
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State | CA
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Zip | 92243-4747
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Country | US
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Telephone | 760-353-9000
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Fax | 760-353-9888
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Provider Business Mailing Address
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Address Line | 1692 S 4TH ST STE F
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City | EL CENTRO
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State | CA
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Zip | 92243-4747
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Country | US
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Telephone | 760-353-9000
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Fax | 760-353-9888
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRAHMAJI VALIVETI
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Credential |
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Telephone | 917-676-1811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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