Provider Demographics
NPI:1467088773
Name:IMGRX SJ VALLEY, INC.
Entity Type:Organization
Organization Name:IMGRX SJ VALLEY, INC.
Other - Org Name:UNITED HEALTH CENTERS PHARMACY HURON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, MANAGED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-749-4764
Mailing Address - Street 1:13651 DUBLIN CT
Mailing Address - Street 2:ATTN: CHC PHARMACY DEPT.
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4317
Mailing Address - Country:US
Mailing Address - Phone:281-749-2547
Mailing Address - Fax:614-652-8169
Practice Address - Street 1:17008 13TH ST.
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:HURON
Practice Address - State:CA
Practice Address - Zip Code:93234-9997
Practice Address - Country:US
Practice Address - Phone:004-924-2278
Practice Address - Fax:559-942-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy