=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962890228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EL CENTRO PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2015
-----------------------------------------------------
Last Update Date | 02/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 WAKE AVE
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243-9651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-592-4542
-----------------------------------------------------
Fax | 760-592-4813
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 WAKE AVE
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243-9651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-592-4542
-----------------------------------------------------
Fax | 760-592-4813
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | DR. SANGATI G PATEL
-----------------------------------------------------
Credential | PHARM D.
-----------------------------------------------------
Telephone | 760-234-7812
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 52449
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------