Provider Demographics
NPI:1700263480
Name:DEV PHARMA INC
Entity Type:Organization
Organization Name:DEV PHARMA INC
Other - Org Name:EZRX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOJITRA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:909-764-3060
Mailing Address - Street 1:731 INDIAN HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5305
Mailing Address - Country:US
Mailing Address - Phone:909-764-3060
Mailing Address - Fax:909-764-3061
Practice Address - Street 1:731 INDIAN HILL BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5305
Practice Address - Country:US
Practice Address - Phone:909-764-3060
Practice Address - Fax:909-764-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 533303336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700263480Medicaid
CA59000OtherBOP CA LICENSE