Organization
MAIN STREET PHARMACY INCORPORATED
Active
Other names
MAIN STREET PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
AMELIA GRACE PADILLA RPH (OWNER,RPH,AO)
(951) 279-3125
Entity
Organization
Contact information
Practice address
823 S MAIN ST STE 102, CORONA, CA 92882-3409
(951) 279-3125
(951) 279-3127
Mailing address
823 S MAIN ST STE 102, CORONA, CA 92882-3409
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY46586
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2113786
PK
—
05
—
PHA465860
—
CA
Enumeration date
05/20/2006
Last updated
07/01/2022
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