Provider Demographics
NPI:1629613260
Name:EMPIRE INFUSION PHARMACY INC
Entity Type:Organization
Organization Name:EMPIRE INFUSION PHARMACY INC
Other - Org Name:EMPIRE INFUSION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-777-1363
Mailing Address - Street 1:2025 CHICAGO AVE
Mailing Address - Street 2:UNIT A3
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2315
Mailing Address - Country:US
Mailing Address - Phone:951-777-1363
Mailing Address - Fax:951-444-9577
Practice Address - Street 1:2025 CHICAGO AVE
Practice Address - Street 2:UNIT A3
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2315
Practice Address - Country:US
Practice Address - Phone:951-777-1363
Practice Address - Fax:951-444-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
7996760001OtherMEDICARE DME PTAN