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General NPI Number Information
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NPI Number | 1871631861
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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 | 02/02/2007
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 1692 S 4TH ST # 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 # 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 | MEMBER/RPH
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Name | MR. BRAHMAJI VALIVETI
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Credential | RPH
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Telephone | 760-234-9171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY 50720
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY 50720
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License Number State | CA
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