Provider Demographics
NPI:1942852082
Name:EMPIRE HEALTH GROUP INC
Entity Type:Organization
Organization Name:EMPIRE HEALTH GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOJITRA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:951-677-1100
Mailing Address - Street 1:25021 MADISON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8957
Mailing Address - Country:US
Mailing Address - Phone:951-677-1100
Mailing Address - Fax:951-677-1110
Practice Address - Street 1:25021 MADISON AVE STE 105
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8957
Practice Address - Country:US
Practice Address - Phone:951-677-1100
Practice Address - Fax:951-677-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57379OtherBOARD OF PHARMACY PERMIT