Provider Demographics
NPI:1124711684
Name:RAINCROSS OUTPATIENT PHARMACY INC
Entity type:Organization
Organization Name:RAINCROSS OUTPATIENT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:UPADHYAYULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-892-5828
Mailing Address - Street 1:4646 BROCKTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-0103
Mailing Address - Country:US
Mailing Address - Phone:951-788-4646
Mailing Address - Fax:951-774-2836
Practice Address - Street 1:4646 BROCKTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-0103
Practice Address - Country:US
Practice Address - Phone:951-788-4646
Practice Address - Fax:951-774-2836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy