1457581365 NPI number — VALLEY PHARMACY

Table of content: (NPI 1457581365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457581365 NPI number — VALLEY PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY PHARMACY
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:
VALLEY PHARMACY LLC
Provider Other Organization Name Type Code:
3
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:
1457581365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7744 PORT ARTHUR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92880-3537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-327-8467
Provider Business Mailing Address Fax Number:
623-505-6505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2960 N LITCHFIELD RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOODYEAR
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85395-7822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-505-6500
Provider Business Practice Location Address Fax Number:
623-505-6505
Provider Enumeration Date:
07/27/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GADALLA
Authorized Official First Name:
AMGAD
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
623-505-6500

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  Y005172 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0356243 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".