Provider Demographics
NPI:1073938114
Name:PEACHLAND PHARMACY, INC.
Entity Type:Organization
Organization Name:PEACHLAND PHARMACY, INC.
Other - Org Name:VALENCIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:PENARANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-962-2043
Mailing Address - Street 1:8881 FLETCHER PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3130
Mailing Address - Country:US
Mailing Address - Phone:858-560-1979
Mailing Address - Fax:
Practice Address - Street 1:25050 PEACHLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2523
Practice Address - Country:US
Practice Address - Phone:661-255-7910
Practice Address - Fax:661-255-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144893OtherPK
CA6044550001Medicare NSC