PECHANGA INDIAN HEALTH CLINIC PHARMACY (NPI# 1760728380) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760728380 |
| Entity Type | Organization |
| Organization Name | PECHANGA INDIAN HEALTH CLINIC PHARMACY |
| Other Organization Name | PECHANGA INDIAN HEALTH CLINIC PHARMACY |
| Practice Address |
12784 Pechanga Rd Temecula CA 92592-2903 |
| Mailing Address |
12784 Pechanga Rd Temecula CA 92592 |
| Practice Telephone | 9516766810 |
| Practice Fax Number | 9516766421 |
| Mailing Telephone | 9516766810 |
| Mailing Fax Number | 9516766421 |
| Enumeration Date | 2012-12-31 |
| Last Update Date | 2012-12-31 |
| Authorized Official Name | JESS MONTOYA (CEO) |
| Authorized Official Telephone | 9518494761 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
Suppliers | ||
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 50823 | CA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP PROVIDER IDENTIFICATION NUMBER | 5646178 | 01 |
| Other Name | Type Code |
|---|---|
| Pechanga Indian Health Clinic Pharmacy | Doing Business As Name - Organization |
| Street Address |
12784 PECHANGA RD |
| City | TEMECULA |
| State | CA |
| Zip Code | 92592-2903 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780156554 | Karyn Ann Hardin | Driver | 12784 Pechanga Rd, Temecula, CA 92592 | 2018-12-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366051625 | Huey Q Tran, Dds, Inc. | Dentist | 33321 Temecula Parkway Ste 104, Temecula, CA 92592 | 2020-07-23 |
| 1902425465 | Isak Elkayam | Student in an Organized Health Care Education/Training Program | 31700 Temecula Parkway, Parkway Suites # 2- Gme, Temecula, CA 92592 | 2020-04-14 |
| 1033738737 | Jordan Buckley | Student in an Organized Health Care Education/Training Program | Uhs Socal Medical Education Consortium, 31700 Temecula Parkway Parkway Suites # 2- Gme, Temecula, CA 92592 | 2020-04-13 |
| 1366071052 | Areg Hovsepyan | Internal Medicine | 31700 Temecula Parkway Parkway Suites # 2- Gme, Temecula, CA 92592 | 2020-04-03 |
| 1558906982 | Session Sync, Inc. | Point of Service | 44262 Marcelina Court, Temecula, CA 92592 | 2019-11-08 |
| 1962964718 | Krishna Theja Reddy Venkatamuni Reddy | Student in an Organized Health Care Education/Training Program | Uhs Socal Medical Education Consortium, 31700 Temecula Parkway, Parkway Suites # 2- Gme, Temecula, CA 92592 | 2019-04-02 |
| 1598220246 | Shanay Lamont Moore | Behavior Technician | 30660 Milky Way Dr., V174, Temecula, CA 92592 | 2019-02-07 |
| 1477029502 | Tibbitts Temecula Dental Group | Clinic/Center | 32909 Temecula Parkway Ste 102, Temecula, CA 92592 | 2018-10-16 |
| 1720563364 | Nicole Louise Hernandez | Behavioral Analyst | 32144 Camino Nunez, Temecula, CA 92592 | 2018-09-29 |
| 1174010664 | Kiet Chau | Pharmacist | 32228 Highway 79 South, Temecula, CA 92592 | 2018-04-19 |
| Find all providers in zip 92592 | ||||
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598108847 | Hometown Ltc Pharmacy Inc | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1450 W Mccoy Ln Ste B, Santa Maria, CA 93455-1059 | 2013-04-16 |
| 1144873811 | Hometown Ltc Pharmacy Inc | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1009 E Grand Ave, Arroyo Grande, CA 93420-2504 | 2019-07-22 |
| 1407252588 | Ihc Santa Ysabel Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 110 1/2 School House Canyon Road, Santa Ysabel, CA 92070 | 2014-11-17 |
| 1053484998 | Susanville Indian Rancheria | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 795 Joaquin St, Susanville, CA 96130-3628 | 2006-11-16 |
| 1982782256 | United Indian Health Services Inc | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1600 Weeot Way, Arcata, CA 95521-4734 | 2006-11-02 |
| 1699881540 | Tuolumne Me-wuk Indian Health Center Incorporated | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 18880 Cherry Valley Blvd, Tuolumne, CA 95379-9506 | 2006-08-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.