Provider Demographics
NPI:1851430805
Name:ALTA VIEW HEALTH CARE LLC
Entity Type:Organization
Organization Name:ALTA VIEW HEALTH CARE LLC
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:ABDELQADER A
Authorized Official - Last Name:ALQAZQI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-250-9623
Mailing Address - Street 1:296 H ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4779
Mailing Address - Country:US
Mailing Address - Phone:619-470-4550
Mailing Address - Fax:619-470-6709
Practice Address - Street 1:296 H ST STE 103
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4779
Practice Address - Country:US
Practice Address - Phone:619-470-4550
Practice Address - Fax:619-470-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X
CA558513336L0003X
CA483673336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0597700OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CA1851430805Medicaid
CA1851430805Medicaid
CAFT0164070OtherDEA #