Provider Demographics
NPI:1467658385
Name:RIVERSIDE COUNTY RUBIDOUX PHARMACY
Entity Type:Organization
Organization Name:RIVERSIDE COUNTY RUBIDOUX PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAHANGIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMS-ZAFFARGHANDI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:951-955-2755
Mailing Address - Street 1:5256 MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:RUBIDOUX
Mailing Address - State:CA
Mailing Address - Zip Code:92509
Mailing Address - Country:US
Mailing Address - Phone:951-955-2755
Mailing Address - Fax:
Practice Address - Street 1:5256 MISSION AVE
Practice Address - Street 2:
Practice Address - City:RUBIDOUX
Practice Address - State:CA
Practice Address - Zip Code:92509
Practice Address - Country:US
Practice Address - Phone:951-955-2755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485413336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy