1215511035 NPI number — IMGRX SJ VALLEY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215511035 NPI number — IMGRX SJ VALLEY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMGRX SJ VALLEY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215511035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13651 DUBLIN CT
Provider Second Line Business Mailing Address:
ATTN: CHC PHARMACY DEPT.
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-749-2547
Provider Business Mailing Address Fax Number:
614-652-8169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1790 E MANNING AVE
Provider Second Line Business Practice Location Address:
PHARMACY SUITE
Provider Business Practice Location Address City Name:
REEDLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93654-9467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-492-4227
Provider Business Practice Location Address Fax Number:
559-480-2993
Provider Enumeration Date:
05/07/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, MANAGED SERVICES
Authorized Official Telephone Number:
281-749-4764

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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