Provider Demographics
NPI:1699550400
Name:PARADISE PHARMACY, INC.
Entity type:Organization
Organization Name:PARADISE PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROLANFRANCIS
Authorized Official - Middle Name:ARELLANO
Authorized Official - Last Name:LEGASPI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:858-560-1911
Mailing Address - Street 1:8881 FLETCHER PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3130
Mailing Address - Country:US
Mailing Address - Phone:858-560-1979
Mailing Address - Fax:858-560-9431
Practice Address - Street 1:3940 4TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7193
Practice Address - Country:US
Practice Address - Phone:619-839-0455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy