Provider Demographics
NPI:1235628058
Name:3E PHARMACY INC
Entity Type:Organization
Organization Name:3E PHARMACY INC
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TADROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-977-8667
Mailing Address - Street 1:9194 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3872
Mailing Address - Country:US
Mailing Address - Phone:951-977-8667
Mailing Address - Fax:951-977-8617
Practice Address - Street 1:9194 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3872
Practice Address - Country:US
Practice Address - Phone:951-977-8667
Practice Address - Fax:951-977-8617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 333600000X, 3336C0004X, 3336L0003X
CAPHY561103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No251F00000XAgenciesHome Infusion
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177804OtherPK
CA1235628058Medicaid