Provider Demographics
NPI:1013046713
Name:TEPLOW PHARMACY LLC
Entity Type:Organization
Organization Name:TEPLOW PHARMACY LLC
Other - Org Name:TEPLOW DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAHMAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:VALIVETI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-845-0407
Mailing Address - Street 1:404 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2326
Mailing Address - Country:US
Mailing Address - Phone:760-256-2726
Mailing Address - Fax:760-256-3199
Practice Address - Street 1:404 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2326
Practice Address - Country:US
Practice Address - Phone:760-256-2726
Practice Address - Fax:760-256-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY46890333600000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY57968Medicaid
CAPHA468900Medicaid