Provider Demographics
NPI:1174348122
Name:SAI BEAR CREEK PHARMACY LLC
Entity type:Organization
Organization Name:SAI BEAR CREEK PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGARAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-677-4880
Mailing Address - Street 1:24046 CLINTON KEITH RD STE 107
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-8060
Mailing Address - Country:US
Mailing Address - Phone:951-677-4880
Mailing Address - Fax:
Practice Address - Street 1:24046 CLINTON KEITH RD STE 107
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-8060
Practice Address - Country:US
Practice Address - Phone:951-677-4880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy