1710923321 NPI number — THE VON'S COMPANIES 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 1710923321 NPI number — THE VON'S COMPANIES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE VON'S COMPANIES 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:
VONS PHARMACY #2371
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:
1710923321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20427 N 27TH AVE # MSC4551
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85027-3241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17390 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HESPERIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92345-6153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-948-2445
Provider Business Practice Location Address Fax Number:
760-947-4317
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERS
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MANAGED CARE PLAN SPECIALIST
Authorized Official Telephone Number:
623-869-3524

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHY43012 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHA430120 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0594906 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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