Provider Demographics
NPI:1295195147
Name:VALE ROAD PHARMACY LLC
Entity Type:Organization
Organization Name:VALE ROAD PHARMACY LLC
Other - Org Name:VALE ROAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:SNEHABEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:510-232-2377
Mailing Address - Street 1:2023 VALE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3891
Mailing Address - Country:US
Mailing Address - Phone:510-232-2377
Mailing Address - Fax:510-234-7181
Practice Address - Street 1:2023 VALE RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3891
Practice Address - Country:US
Practice Address - Phone:510-232-2377
Practice Address - Fax:510-234-7181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA542973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159257OtherPK