Organization
RELIANCE IMPERIAL PHARMACY LLC
Active
Other names
FARMACIA DEL PUEBLO
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAHMAJI VALIVETI RPH (MEMBER/RPH)
(760) 234-9171
Entity
Organization
Contact information
Practice address
1692 S 4TH ST, # F, EL CENTRO, CA 92243-4747
(760) 353-9000
(760) 353-9888
Mailing address
1692 S 4TH ST, # F, EL CENTRO, CA 92243-4747
(760) 353-9000
(760) 353-9888
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY 50720
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY 50720
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5625946
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
PHY 50720
RETAIL PHARMACY PERMIT
CA
Enumeration date
02/02/2007
Last updated
10/16/2024
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