Provider Demographics
NPI:1467410316
Name:IMPERIAL VALLEY PHARMACY, INC.
Entity Type:Organization
Organization Name:IMPERIAL VALLEY PHARMACY, INC.
Other - Org Name:VALLEY PHAMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-357-3520
Mailing Address - Street 1:2451 ROCKWOOD AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-4404
Mailing Address - Country:US
Mailing Address - Phone:760-357-3520
Mailing Address - Fax:
Practice Address - Street 1:2451 ROCKWOOD AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-4404
Practice Address - Country:US
Practice Address - Phone:760-357-3520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy