Provider Demographics
NPI:1346352267
Name:PARKVIEW MEDICAL PLAZA PHARMACY INC
Entity Type:Organization
Organization Name:PARKVIEW MEDICAL PLAZA PHARMACY INC
Other - Org Name:PARKVIEW MEDICAL PLAZA PHARMACY
Other - Org Type:Doing Business As
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:
Authorized Official - Phone:951-892-5828
Mailing Address - Street 1:3975 JACKSON ST
Mailing Address - Street 2:STE 109
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3901
Mailing Address - Country:US
Mailing Address - Phone:951-637-0180
Mailing Address - Fax:951-637-0183
Practice Address - Street 1:3975 JACKSON ST
Practice Address - Street 2:STE 109
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3901
Practice Address - Country:US
Practice Address - Phone:951-637-0180
Practice Address - Fax:951-637-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X, 3336M0002X, 3336M0003X, 3336S0011X
CAPHY431373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2002122OtherPK
CAPHA431370Medicaid
1200950001Medicare NSC