Provider Demographics
NPI:1871631861
Name:RELIANCE IMPERIAL PHARMACY LLC
Entity Type:Organization
Organization Name:RELIANCE IMPERIAL PHARMACY LLC
Other - Org Name:FARMACIA DEL PUEBLO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAHMAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:VALIVETI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:760-234-9171
Mailing Address - Street 1:1692 S 4TH ST
Mailing Address - Street 2:# F
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4747
Mailing Address - Country:US
Mailing Address - Phone:760-353-9000
Mailing Address - Fax:760-353-9888
Practice Address - Street 1:1692 S 4TH ST
Practice Address - Street 2:# F
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4747
Practice Address - Country:US
Practice Address - Phone:760-353-9000
Practice Address - Fax:760-353-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 50720333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5625946OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHY 50720OtherRETAIL PHARMACY PERMIT