Provider Demographics
NPI:1437145299
Name:WILLOW VALLEY PHARMACY, INC., DBA
Entity Type:Organization
Organization Name:WILLOW VALLEY PHARMACY, INC., DBA
Other - Org Name:NEEDLES POINT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RESPONSIBLE PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:POCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:760-326-2312
Mailing Address - Street 1:1101 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-2704
Mailing Address - Country:US
Mailing Address - Phone:760-326-2312
Mailing Address - Fax:760-326-4178
Practice Address - Street 1:1101 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-2704
Practice Address - Country:US
Practice Address - Phone:760-326-2312
Practice Address - Fax:760-326-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY33276333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA332760Medicaid
CA05-87482OtherNABP