Fullerton Pharmacy, Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

FULLERTON PHARMACY, INC.

Doing business as

Fullerton Pharmacy

Practice address

1820 Fullerton Ave.
Ste. 105
Corona, CA 92881-3160

Phone

(951) 496-4222

NPI assigned

Sep 19, 2020

Last updated

Feb 15, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sirisha Palavalli

Title

Ceo/Cfo/Sec./Dir.

Phone

(951) 496-4222

Specialties & licenses 2

Addresses

Other names 1

• Fullerton Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Chandrasekhar Eadara

  • Pharmacist
  • Riverside, CA
  • NPI 1053855585
  NPD (past)
• Raana Sidky

  • Pharmacist
  • Riverside, CA
  • NPI 1891107850
  NPD (past)

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

{
    "created_epoch": "1600473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707955200000",
    "number": "1952917528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 FULLERTON AVE.",
            "address_2": "STE. 105",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928813160",
            "telephone_number": "951-496-4222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 FULLERTON AVE.",
            "address_2": "STE. 105",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928813160",
            "telephone_number": "951-496-4222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLERTON PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-19",
        "last_updated": "2024-02-15",
        "certification_date": "2020-09-19",
        "status": "A",
        "authorized_official_last_name": "PALAVALLI",
        "authorized_official_first_name": "SIRISHA",
        "authorized_official_title_or_position": "CEO/CFO/SEC./DIR.",
        "authorized_official_telephone_number": "951-496-4222"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fullerton Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jaelyn Fudge
• Bridget Fuentes
• David Fukuchi
• Dante Vincent Fulgenzi, DPT
• Fullerton Health Inc (Fullerton Pharmacy)
• Navid Parviz Furutan, MD
• Holly Diane Fyda, NP
• Kathryn Ellorin Gabot-Puhawan, M.D.
• Naomi Mikiko Gabot, R.N.
• Gabriela Care Home, Inc.

• Pharmacy in Corona, CA
• Providers in Corona, CA by specialty
• Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.