Provider Demographics
NPI:1528793072
Name:NISHA PHARMACY INC
Entity type:Organization
Organization Name:NISHA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:UMESHBHAI
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-220-0373
Mailing Address - Street 1:1240 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5116
Mailing Address - Country:US
Mailing Address - Phone:714-220-0373
Mailing Address - Fax:714-220-1462
Practice Address - Street 1:1240 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5116
Practice Address - Country:US
Practice Address - Phone:714-220-0373
Practice Address - Fax:714-220-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0595237OtherNCPDP
0769560001OtherMEDICARE PTAN
CAPHA395120Medicaid