Imperial Beach Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

IMPERIAL BEACH PHARMACY LLC

Practice address

1530 Palm Ave
San Diego, CA 92154-1016

Phone

(619) 343-0095

Fax

(619) 830-4590

NPI assigned

Sep 6, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Prashant Amrutlal Koyani, PHARMDNPI 1871153874

Title

Member

Phone

(619) 343-0095

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Imperial Beach Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Imperial Beach Pharmacy LLC

  • Long Term Care Pharmacy
  • San Diego, CA
  • NPI 1558125856
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Prashant Amrutlal Koyani, PHARMD

  • Pharmacist
  • San Diego, CA
  • NPI 1871153874
  NPD Authorized official

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

{
    "created_epoch": "1599350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707350400000",
    "number": "1326652371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 PALM AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921541016",
            "telephone_number": "619-343-0095",
            "fax_number": "619-830-4590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 PALM AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921541016",
            "telephone_number": "619-343-0095",
            "fax_number": "619-830-4590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPERIAL BEACH PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-06",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A",
        "authorized_official_last_name": "KOYANI",
        "authorized_official_first_name": "PRASHANT",
        "authorized_official_middle_name": "AMRUTLAL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "619-343-0095",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Impedimed Inc
• Shannon Imper, LMFT
• Imperial Beach Community Clinic
• Imperial Beach Optometric Corporation
• Imperial Beach Pharmacy LLC
• Imperial Beach Pharmacy LLC
• Imperial Medical Health Care Group, Inc
• Imperial Medical Transport Inc
• Imperial Valley Optometric Corporation
• Imperial Valley Optometric Corporation

• Community/Retail Pharmacy in San Diego, CA
• Providers in San Diego, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.