NPIMap

Individual provider Active NPI

Gholam H Rouzitalab, RPH

  • Pharmacist
  • Lake Elsinore, CA
National Provider Identifier
1306359534
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
38471 Issued in CA
Practice address
16800 Lakeshore Dr # 3
Lake Elsinore, CA 92530-4909
Phone
(951) 674-6836
Fax
(951) 674-9773
NPI assigned
Nov 9, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 38471 CA Primary

Addresses

Primary practice location

16800 Lakeshore Dr # 3
Lake Elsinore, CA 92530-4909

Mailing address

16800 Lakeshore Dr # 3
Lake Elsinore, CA 92530-4909
Phone (951) 674-6836

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
38471CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Nipomo Pharmacy Inc Current Accepting new patients
Gen-RX-Drugs Current Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510185600000",
    "number": "1306359534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16800 LAKESHORE DR # 3",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925304909",
            "telephone_number": "951-674-6836",
            "fax_number": "951-674-9773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16800 LAKESHORE DR # 3",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925304909",
            "telephone_number": "951-674-6836",
            "fax_number": "951-674-9773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUZITALAB",
        "first_name": "GHOLAM",
        "middle_name": "H",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-09",
        "last_updated": "2017-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "38471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Elsinore, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.