Desert Hills RX LLC
Organization Active NPI Community/Retail Pharmacy · Blythe, CA
NPI 1811097652 · NPPES record last updated Oct 29, 2024
Key facts
- NPI
- 1811097652
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- DESERT HILLS RX LLC
- Practice address
- 301 W Hobsonway
Blythe, CA 92225-1639 - Phone
- (760) 922-3511
- Fax
- (760) 922-4404
- NPI assigned
- Sep 22, 2006
- Organization subpart
- No
Authorized official
- Name
- Ridhish Patel
- Title
- Managing Member
- Phone
- (760) 922-3511
Practitioners 3
-
Hung Duy Nguyen, RPH
-
In Il Kim, PHARM.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0967406 | Blythe Mart Pharmacy | Certificate of waiver | Nov 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120703000159 | CA | Part B Supplier - Mass Immunization (Roster Biller Only) | 1355506064 | Practice locations: Blythe, CA |
| O20180822002506 | CA | DME Supplier - Pharmacy | 8224387386 | Practice locations: Blythe, CA |
| O20181012002550 | CA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224387386 | Practice locations: Blythe, CA |
National Provider Directory
Locations
301 W Hobsonway
Blythe, CA 92225
Phone (760) 922-3511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
301 W Hobsonway
Blythe, CA 92225-1639
Mailing address
301 W Hobsonway
Blythe, CA 92225-1639
Phone (760) 922-3511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHY60464 | Other | CA | BOARD OF PHARMACY |
Other names
- BLYTHE MART PHARMACY
Other providers in Blythe, CA
- Theresa Rodriguez Davila
- Ashley Christine Defreese
- Ramiro Delgado Jr.
- Desert Air Ambulance Inc
- Desert Critical Care Transport, Inc.
- Desert View Medical
- Dharia DDS Professional Dental Corporation
- David DO
- Gregory C. Doane
- Frank Wayne Dudley Jr.
All providers in Blythe, 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 Oct 29, 2024. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.