Archana Corporation
Organization Active NPI Community/Retail Pharmacy · Lakeside, CA
NPI 1811048069 · NPPES record last updated Apr 5, 2017
Key facts
- NPI
- 1811048069
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 50422 (CA)
- Legal business name
- ARCHANA CORPORATION
- Practice address
- 9943 Maine Ave
Lakeside, CA 92040-3107 - Phone
- (619) 443-1013
- Fax
- (619) 443-8517
- NPI assigned
- Jan 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Ramesh Rakholia, B. PHARM
- Title
- President
- Phone
- (619) 287-7697
Corporate family (same tax ID) 1
Member organizations 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110121000588 | CA | DME Supplier - Pharmacy | 0143420265 | Practice locations: Lakeside, CA |
| O20110714000547 | CA | Part B Supplier - Mass Immunization (Roster Biller Only) | 0143420265 | Practice locations: Lakeside, CA |
National Provider Directory
- Tax ID family
- Archana Corporation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 50422 | CA | Yes |
| Long Term Care Pharmacy | 3336L0003X | |||
| Specialty Pharmacy | 3336S0011X |
Addresses
Primary practice location
9943 Maine Ave
Lakeside, CA 92040-3107
Mailing address
9943 Maine Ave
Lakeside, CA 92040-3107
Phone (619) 443-1013
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2127309 | Other | PK | |
| 1811048069 03 | Medicaid | CA |
Other names
- Leo's Lakeside Pharmacy
Other providers in Lakeside, CA
- Jennifer Mary Ann Anderson
- Steven R Anderson Sr.
- Victor Josue Andrade
- Matthew Timothy Angquico
- Archana Corporation
- Ginger Lea Armstrong
- Arthur Santos DDS Corp
- Cesar Ayala
- Bailey Associates Inc
- Bailey Associates Inc.
All providers in Lakeside, CA · Community/Retail Pharmacy in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 5, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.