Provider Demographics
NPI:1003244526
Name:WEST VALLEY PHARMACY LLC
Entity Type:Organization
Organization Name:WEST VALLEY PHARMACY LLC
Other - Org Name:WEST VALLEY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-422-8477
Mailing Address - Street 1:12851 W BELL RD
Mailing Address - Street 2:STE 110
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9600
Mailing Address - Country:US
Mailing Address - Phone:623-533-6514
Mailing Address - Fax:623-518-2860
Practice Address - Street 1:12851 W BELL RD
Practice Address - Street 2:STE 110
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9600
Practice Address - Country:US
Practice Address - Phone:623-533-6514
Practice Address - Fax:623-518-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH03717333600000X
AZY0070353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167206OtherPK
AZ886564Medicaid