MEDICARE: SIDDHAYE CORPORATION

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
2	3336C0003X	Community/Retail Pharmacy	PHY45473	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0563177	OTHER	NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1982773834	OTHER	NPI

General Provider Information

NPI Number	:	1982773834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIDDHAYE CORPORATION

Provider Business Mailing Address
First Line	:	12818 HEACOCK ST
Second Line	:	STE C 5
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-3173
Country	:	US
Telephone Number	:	951-247-3501
Fax Number	:	951-243-1702

Provider Business Practice Location Address
First Line	:	12818 HEACOCK ST
Second Line	:	STE C 5
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-3173
Country	:	US
Telephone Number	:	951-247-3501
Fax Number	:	951-243-1702

Authorized Official
Title or Position	:	OWNER
Name	:	MEETA PATEL
Credential	:
Telephone Number	:	951-247-3501

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	09/19/2023

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Directions to “SIDDHAYE CORPORATION ” Practice Location

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