1215511035 NPI number — IMGRX SJ VALLEY, INC.

Table of content: (NPI 1215511035)

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)