Provider Demographics
NPI:1407401946
Name:TRI CITY RX PHARMACY, INC.
Entity Type:Organization
Organization Name:TRI CITY RX PHARMACY, INC.
Other - Org Name:TRI CITY RX PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VRUNDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:760-963-6199
Mailing Address - Street 1:PO BOX 3310
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-3310
Mailing Address - Country:US
Mailing Address - Phone:760-946-1414
Mailing Address - Fax:
Practice Address - Street 1:15940 QUANTICO RD STE 100
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1300
Practice Address - Country:US
Practice Address - Phone:760-946-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407401946Medicaid