Provider Demographics
NPI:1376660720
Name:A.V. PHARMACY
Entity Type:Organization
Organization Name:A.V. PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:THAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-272-6970
Mailing Address - Street 1:38750 TRADE CENTER DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3787
Mailing Address - Country:US
Mailing Address - Phone:661-272-6970
Mailing Address - Fax:
Practice Address - Street 1:38750 TRADE CENTER DR
Practice Address - Street 2:SUITE G
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3787
Practice Address - Country:US
Practice Address - Phone:661-272-6970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty