MEDICARE: UNICARE CALI HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PHY45319	CA
2	3336L0003X	Long Term Care Pharmacy	PHY45319	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0596683	OTHER		NCPDP NUMBER

General Provider Information

NPI Number	:	1053395921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNICARE CALI HEALTH INC

Provider Business Mailing Address
First Line	:	930 S MOUNT VERNON AVE STE 100
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-3928
Country	:	US
Telephone Number	:	909-317-3100
Fax Number	:	909-317-3101

Provider Business Practice Location Address
First Line	:	930 S MOUNT VERNON AVE STE 100
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-3928
Country	:	US
Telephone Number	:	909-317-3100
Fax Number	:	909-317-3101

Authorized Official
Title or Position	:	SECRETARY/PHARMACIST
Name	:	MR. GOPAL SOJITRA
Credential	:	PHARM D
Telephone Number	:	909-317-3100

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	05/15/2019

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Directions to “UNICARE CALI HEALTH INC ” Practice Location

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