Provider Demographics
NPI:1669018727
Name:EL MIRADOR MEDICAL PLAZA PHARMACY INC
Entity Type:Organization
Organization Name:EL MIRADOR MEDICAL PLAZA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:UPADHYAYULA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:760-323-1001
Mailing Address - Street 1:1180 N INDIAN CANYON DR STE E140
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4883
Mailing Address - Country:US
Mailing Address - Phone:760-323-1001
Mailing Address - Fax:760-323-1144
Practice Address - Street 1:1180 N INDIAN CANYON DR STE E140
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4883
Practice Address - Country:US
Practice Address - Phone:760-323-1001
Practice Address - Fax:760-323-1144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EL MIRADOR MEDICAL PLAZA PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-25
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy