Provider Demographics
NPI:1962739425
Name:RANCHO MIRAGE PHARMACY, INC.
Entity type:Organization
Organization Name:RANCHO MIRAGE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:MENG-FENG
Authorized Official - Last Name:HSIEH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-235-4237
Mailing Address - Street 1:72-780 COUNTRY CLUB DR.
Mailing Address - Street 2:BLD D-400
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-340-1130
Mailing Address - Fax:760-340-1150
Practice Address - Street 1:72-780 COUNTRY CLUB DR.
Practice Address - Street 2:BLD D-400
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-340-1130
Practice Address - Fax:760-340-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY498443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy