Provider Demographics
NPI:1740295385
Name:PEOPLES PHARMACY
Entity type:Organization
Organization Name:PEOPLES PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:RASHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDIRATTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:949-713-9400
Mailing Address - Street 1:31951 DOVE CANYON DR
Mailing Address - Street 2:STE F
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3749
Mailing Address - Country:US
Mailing Address - Phone:949-713-9400
Mailing Address - Fax:949-713-9494
Practice Address - Street 1:31951 DOVE CANYON DR
Practice Address - Street 2:STE F
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-3749
Practice Address - Country:US
Practice Address - Phone:949-713-9400
Practice Address - Fax:949-713-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY473033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2113794OtherPK