Organization
RELIANCE IMPERIAL PHARMACY LLC
Active
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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