Provider Demographics
NPI:1124199542
Name:LAMONT HEALTHCARE INC
Entity Type:Organization
Organization Name:LAMONT HEALTHCARE INC
Other - Org Name:VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-735-7077
Mailing Address - Street 1:10400 MAIN ST
Mailing Address - Street 2:STE D
Mailing Address - City:LAMONT
Mailing Address - State:CA
Mailing Address - Zip Code:93241-1727
Mailing Address - Country:US
Mailing Address - Phone:661-735-7077
Mailing Address - Fax:661-735-7407
Practice Address - Street 1:10400 MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:LAMONT
Practice Address - State:CA
Practice Address - Zip Code:93241-1727
Practice Address - Country:US
Practice Address - Phone:661-735-7077
Practice Address - Fax:661-735-7407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2022-04-15
Deactivation Date:2017-07-17
Deactivation Code:
Reactivation Date:2018-04-12
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 333600000X, 3336C0004X, 3336L0003X, 3336S0011X
CAPHY561193336C0003X
CAPHY483633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124199542Medicaid
CA1124199542Medicaid
1223230001Medicare NSC
CAPHA483630Medicaid