Provider Demographics
NPI:1275627671
Name:ASHAPURIMAA INC
Entity Type:Organization
Organization Name:ASHAPURIMAA INC
Other - Org Name:SIERRA SAN ANTONIO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:909-574-9620
Mailing Address - Street 1:16465 SIERRA LAKES PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1242
Mailing Address - Country:US
Mailing Address - Phone:909-574-9620
Mailing Address - Fax:909-574-9621
Practice Address - Street 1:16465 SIERRA LAKES PKWY
Practice Address - Street 2:STE 110
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1242
Practice Address - Country:US
Practice Address - Phone:909-574-9620
Practice Address - Fax:909-574-9621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5622104OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA1275627671Medicaid
CA6307850001Medicare NSC