Provider Demographics
NPI:1699730291
Name:ALLIANCE MEDICAL EQUIPMENT & RESP. PHARMACY, INC
Entity type:Organization
Organization Name:ALLIANCE MEDICAL EQUIPMENT & RESP. PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:INDRAVADAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:909-635-1155
Mailing Address - Street 1:3100 E CEDAR ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7693
Mailing Address - Country:US
Mailing Address - Phone:909-635-1155
Mailing Address - Fax:909-635-1161
Practice Address - Street 1:3100 E CEDAR ST
Practice Address - Street 2:SUITE 13
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7693
Practice Address - Country:US
Practice Address - Phone:909-635-1155
Practice Address - Fax:909-635-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 45480333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 454800Medicaid
CAPHY 454800Medicaid