Main Street Pharmacy Incorporated

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY46586 Issued in CA

Legal business name

MAIN STREET PHARMACY INCORPORATED

Practice address

823 S Main St Ste 102
Corona, CA 92882-3409

Phone

(951) 279-3125

Fax

(951) 279-3127

NPI assigned

May 20, 2006

Organization subpart

No

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

Authorized official

Name

Amelia Grace Padilla, RPHNPI 1992752216

Title

Owner,RPH,Ao

Phone

(951) 279-3125

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• MAIN STREET PHARMACY INC Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

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

• Amelia Grace Gines Padilla, RPH

  • Pharmacist
  • Corona, CA
  • NPI 1992752216
  NPD Authorized official
• Maria Cecilia Rivera Kaw, RPH

  • Pharmacist
  • Corona, CA
  • NPI 1518912617
  NPD (past)

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656633600000",
    "number": "1821042383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 S MAIN ST STE 102",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928823409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 S MAIN ST STE 102",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928823409",
            "telephone_number": "951-279-3125",
            "fax_number": "951-279-3127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET PHARMACY INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2022-07-01",
        "certification_date": "2022-07-01",
        "status": "A",
        "authorized_official_last_name": "PADILLA",
        "authorized_official_first_name": "AMELIA GRACE",
        "authorized_official_title_or_position": "OWNER,RPH,AO",
        "authorized_official_telephone_number": "951-279-3125",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY46586",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2113786",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA465860",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAIN STREET PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MAIN STREET PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mohammad Alamgir Mahmud, MD, MPH, PHD
• John William Mahon, D.D.S.
• Mahraj Corp.
• Michael T. Mai, MD
• Main Street Pharmacy Incorporated
• Mainbridge Surgery Center Inc.
• Makadia and Shah Dental Office
• Radhika Makadia, D.M.D., B.D.S.
• Mustafa Ahmedali Makati, D.D.S.
• Brandon Malcolm

• Community/Retail Pharmacy in Corona, CA
• Providers in Corona, 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 Jul 1, 2022; 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.