Provider Demographics
NPI:1043785983
Name:COACHELLA VALLEY PHARMACY INC
Entity Type:Organization
Organization Name:COACHELLA VALLEY PHARMACY INC
Other - Org Name:COACHELLA VALLEY LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEACHY
Authorized Official - Middle Name:U
Authorized Official - Last Name:LUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-399-2828
Mailing Address - Street 1:35900 BOB HOPE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1765
Mailing Address - Country:US
Mailing Address - Phone:760-565-0629
Mailing Address - Fax:
Practice Address - Street 1:35900 BOB HOPE DR STE 105
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1765
Practice Address - Country:US
Practice Address - Phone:760-565-0629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy