Provider Demographics
NPI:1104909258
Name:RANCHO DRUGS INC
Entity type:Organization
Organization Name:RANCHO DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/CEO/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOJITRA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:760-242-4900
Mailing Address - Street 1:17798 WIKA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1219
Mailing Address - Country:US
Mailing Address - Phone:760-242-4900
Mailing Address - Fax:760-242-8962
Practice Address - Street 1:17798 WIKA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1219
Practice Address - Country:US
Practice Address - Phone:760-242-4900
Practice Address - Fax:760-242-8962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY226093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA226090Medicaid
2002594OtherPK
5515970001Medicare NSC