Provider Demographics
NPI:1609116649
Name:ANJANEYA RX
Entity type:Organization
Organization Name:ANJANEYA RX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TARUN
Authorized Official - Middle Name:SHYAM
Authorized Official - Last Name:WADHWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-972-0372
Mailing Address - Street 1:3601 VISTA WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4559
Mailing Address - Country:US
Mailing Address - Phone:310-972-0372
Mailing Address - Fax:
Practice Address - Street 1:3601 VISTA WAY STE 103
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056
Practice Address - Country:US
Practice Address - Phone:310-972-0372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY511553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy