Provider Demographics
NPI:1407256720
Name:EGYPTIAN INC
Entity Type:Organization
Organization Name:EGYPTIAN INC
Other - Org Name:TRUCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-817-1005
Mailing Address - Street 1:1875 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-6477
Mailing Address - Country:US
Mailing Address - Phone:951-817-1005
Mailing Address - Fax:951-817-1020
Practice Address - Street 1:1875 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-6477
Practice Address - Country:US
Practice Address - Phone:951-817-1005
Practice Address - Fax:951-817-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY518853336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147466OtherPK