Provider Demographics
NPI:1114245495
Name:PARKVIEW MEDICAL PLAZA PHARMACY LTC
Entity Type:Organization
Organization Name:PARKVIEW MEDICAL PLAZA PHARMACY LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:951-892-5828
Mailing Address - Street 1:3975 JACKSON ST STE 111
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:951-637-7054
Mailing Address - Fax:
Practice Address - Street 1:3975 JACKSON ST STE 111
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3946
Practice Address - Country:US
Practice Address - Phone:951-637-7054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKVIEW MEDICAL PLAZA PHARMCY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY501953336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy