Provider Demographics
NPI:1639769920
Name:EMPIRE INFUSION PHARMACY, INC.
Entity Type:Organization
Organization Name:EMPIRE INFUSION PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:951-367-7044
Mailing Address - Street 1:2025 CHICAGO AVE STE A3
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2315
Mailing Address - Country:US
Mailing Address - Phone:951-367-7044
Mailing Address - Fax:951-530-4801
Practice Address - Street 1:2025 CHICAGO AVE STE A3
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2315
Practice Address - Country:US
Practice Address - Phone:951-367-7044
Practice Address - Fax:951-530-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy