=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922394915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R & G PHARMACIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2011
-----------------------------------------------------
Last Update Date | 06/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9943 MAINE AVE
-----------------------------------------------------
City | LAKESIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92040-3107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-443-1013
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9943 MAINE AVE
-----------------------------------------------------
City | LAKESIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92040-3107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-443-1013
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RAMESH RAKHOLIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-443-1013
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 50062
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------