Provider Demographics
NPI:1407889819
Name:VALLEY MEDICAL PHARMACY
Entity Type:Organization
Organization Name:VALLEY MEDICAL PHARMACY
Other - Org Name:MANOR DRUG MEDICAL & MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:YOSHIKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-431-4142
Mailing Address - Street 1:5795 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6294
Mailing Address - Country:US
Mailing Address - Phone:559-431-4142
Mailing Address - Fax:559-431-4357
Practice Address - Street 1:5795 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6294
Practice Address - Country:US
Practice Address - Phone:559-431-4142
Practice Address - Fax:559-431-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407889819Medicaid
CAPHY57382OtherSTATE BOARD OF PHARMACY
CAPHY46920OtherSTATE BOARD OF PHARMACY