Provider Demographics
NPI:1093405003
Name:EL MIRADOR MEDICAL PLAZA PHARMACY INC
Entity Type:Organization
Organization Name:EL MIRADOR MEDICAL PLAZA PHARMACY INC
Other - Org Name:RMC PHARMACY BROCKTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:UPADHYAYULA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:760-323-1001
Mailing Address - Street 1:3975 JACKSON ST STE 109
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3946
Mailing Address - Country:US
Mailing Address - Phone:951-637-0180
Mailing Address - Fax:951-637-0183
Practice Address - Street 1:7117 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2658
Practice Address - Country:US
Practice Address - Phone:951-638-0180
Practice Address - Fax:951-637-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy