Siddhaye Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY45473 Issued in CA

Legal business name

SIDDHAYE CORPORATION

Practice address

12818 Heacock St
Ste C 5
Moreno Valley, CA 92553-3173

Phone

(951) 247-3501

Fax

(951) 243-1702

NPI assigned

Nov 7, 2006

Organization subpart

No

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

Authorized official

Name

Meeta PatelNPI 1780038935

Title

Owner

Phone

(951) 247-3501

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• MEDICAL PLAZA PHARMACY 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.

• Meeta Patel

  • Pharmacist
  • Moreno Valley, CA
  • NPI 1780038935
  NPD Authorized official
• Ritesh Patel

  • Pharmacist
  • Moreno Valley, CA
  • NPI 1962856120
  NPD (past)

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695081600000",
    "number": "1982773834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12818 HEACOCK ST",
            "address_2": "STE C 5",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925533173",
            "telephone_number": "951-247-3501",
            "fax_number": "951-243-1702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12818 HEACOCK ST",
            "address_2": "STE C 5",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925533173",
            "telephone_number": "951-247-3501",
            "fax_number": "951-243-1702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIDDHAYE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-18",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "MEETA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-247-3501"
    },
    "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": "PHY45473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0563177",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA454730",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1982773834",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL PLAZA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MEDICAL PLAZA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charli Louise Shipman, MS, CCC-SLP
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• Edward Halomoan Siahaan, MS, MBA, MFT INTERN
• Fareeha Sial
• Imran Ahmed Siddiqi, DO
• Rachel Sier, DO
• Matthew Paul Sierra, PHARMD
• Sigma Beta XI Inc.
• Sigma Beta XI Inc.

• Community/Retail Pharmacy in Moreno Valley, CA
• Providers in Moreno Valley, 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 19, 2023; 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.