Provider Demographics
NPI:1376640110
Name:VALLEY PHARMACY SERVICES
Entity Type:Organization
Organization Name:VALLEY PHARMACY SERVICES
Other - Org Name:VALLEY PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:559-635-2674
Mailing Address - Street 1:500 N GARDEN ST
Mailing Address - Street 2:STE 4
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5067
Mailing Address - Country:US
Mailing Address - Phone:559-635-2674
Mailing Address - Fax:559-635-2681
Practice Address - Street 1:500 N GARDEN ST
Practice Address - Street 2:STE 4
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5067
Practice Address - Country:US
Practice Address - Phone:559-635-2674
Practice Address - Fax:559-635-2681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
CAPHY445803336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2094390OtherPK
CAPHA445800Medicaid