Imgrx Sonoma Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY54507 Issued in CA

Legal business name

IMGRX SONOMA INC

Practice address

19270 Sonoma Hwy, Suite a
Sonoma, CA 95476

Phone

(512) 596-2930

Fax

(707) 939-6056

NPI assigned

Jun 3, 2016

Organization subpart

Yes

Parent organization

IMGRX SONOMA INCAs reported in NPPES

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

Authorized official

Name

Michael Brown

Title

Vice President, Managed Services

Phone

(281) 749-4764

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Sonoma Valley Community Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Part of

Imgrx Sonoma Inc

Locations

Practitioners 1

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

• Naveen Mansukhani, R.PH

  • Pharmacist
  • New York, NY
  • NPI 1689850588
  NPD

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663200000000",
    "number": "1952759664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13651 DUBLIN CT",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774774317",
            "telephone_number": "281-749-4000",
            "fax_number": "614-652-0326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19270 SONOMA HWY, SUITE A",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "95476",
            "telephone_number": "512-596-2930",
            "fax_number": "707-939-6056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMGRX SONOMA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IMGRX SONOMA INC",
        "enumeration_date": "2016-06-03",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-13",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE PRESIDENT, MANAGED SERVICES",
        "authorized_official_telephone_number": "281-749-4764"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY54507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2163676",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sonoma Valley Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sonoma Valley Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David N Humphrey
• Alicia Hunt
• Victor E Iacovoni, M.D.
• Yohkheved Rakhel Ihejirika
• Ikigai Consulting & Nursing Corp
• Incare Home Care, LLC
• Timothy Dean Irish, DDS, MSD
• Ishka LLC
• Ishka LLC
• Alexander Eugene Ivanoff, DDS

• Community/Retail Pharmacy in Sonoma, CA
• Providers in Sonoma, 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 Sep 15, 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.