Organization
SIRISANSH LLC
Active
Other names
Parke Vista Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SIRISHA PALAVALLI (MANAGER MEMBER)
(951) 687-4203
Entity
Organization
Contact information
Practice address
3838 SHERMAN DR., STE. 1, RIVERSIDE, CA 92503
(951) 687-4203
(909) 687-1145
Mailing address
3838 SHERMAN DR., STE. 1, RIVERSIDE, CA 92503
(951) 687-4203
(909) 687-1145
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
55696
CA
3336L0003X
Long Term Care Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1995845
PK
—
05
—
PHA420140
—
CA
Enumeration date
06/23/2006
Last updated
03/11/2024
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