1689372393 NPI number — MED CHOICE LTC PHARMACY LLC

Table of content: (NPI 1689372393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689372393 NPI number — MED CHOICE LTC PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED CHOICE LTC PHARMACY LLC
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:
Provider Other Organization Name Type Code:
6
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:
1689372393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3838 SHERMAN DR STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92503-4001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-637-3399
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 E ORANGEBURG AVE STE B3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95355-3472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-298-1715
Provider Business Practice Location Address Fax Number:
559-369-2408
Provider Enumeration Date:
02/21/2023

Additional Information

Authorized Official

Authorized Official Last Name:
ANNE
Authorized Official First Name:
PRATAP
Authorized Official Middle Name:
KRISHNA
Authorized Official Title or Position:
PHARMACY OWNER
Authorized Official Telephone Number:
209-298-1715

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60512 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com