Provider Demographics
NPI:1922394915
Name:R & G PHARMACIES, INC.
Entity Type:Organization
Organization Name:R & G PHARMACIES, INC.
Other - Org Name:LEO'S LAKESIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKHOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-443-1013
Mailing Address - Street 1:9943 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-3107
Mailing Address - Country:US
Mailing Address - Phone:619-443-1013
Mailing Address - Fax:
Practice Address - Street 1:9943 MAINE AVE
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-3107
Practice Address - Country:US
Practice Address - Phone:619-443-1013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50062333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0773310001Medicare NSC