1295804144 NPI number — ROYAL PHARMACY GROUP INC

Table of content: (NPI 1295804144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295804144 NPI number — ROYAL PHARMACY GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROYAL PHARMACY GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROYAL PHARMACY GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295804144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5115 GARFIELD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91941-5122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-282-1338
Provider Business Mailing Address Fax Number:
619-282-1227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5115 GARFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-5122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-282-1338
Provider Business Practice Location Address Fax Number:
619-282-1227
Provider Enumeration Date:
11/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PAGE
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER /PRESIDENT /PIC
Authorized Official Telephone Number:
619-282-1338

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1295804144 . This is a "MEDI-CAL PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHY57165 . This is a "CALIFORNIA STATE BOARD OF PHARMACY RETAIL PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0508020 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".