MEDICARE: PHURANDA 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	3336C0003X	Community/Retail Pharmacy	PHY49014	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

General Provider Information

NPI Number	:	1578710570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHURANDA INC.

Provider Business Mailing Address
First Line	:	15721 BERNARDO HEIGHTS PKWY STE L
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3176
Country	:	US
Telephone Number	:	858-451-2611
Fax Number	:	858-451-6324

Provider Business Practice Location Address
First Line	:	15721 BERNARDO HEIGHTS PKWY STE L
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3176
Country	:	US
Telephone Number	:	858-451-2611
Fax Number	:	858-451-6324

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	ARAM PENARANDA
Credential	:	PHARM D.
Telephone Number	:	858-451-2611

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	08/20/2008

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Directions to “PHURANDA INC. ” Practice Location

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