Provider Demographics
NPI:1568637783
Name:SPRING VALLEY PHARMACY
Entity Type:Organization
Organization Name:SPRING VALLEY PHARMACY
Other - Org Name:SPRING VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:702-248-4119
Mailing Address - Street 1:2725 S JONES BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5667
Mailing Address - Country:US
Mailing Address - Phone:702-248-4119
Mailing Address - Fax:702-248-6884
Practice Address - Street 1:2725 S JONES BLVD
Practice Address - Street 2:STE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5667
Practice Address - Country:US
Practice Address - Phone:702-248-4119
Practice Address - Fax:702-248-6884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336S0011X
NVPH023753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2052303OtherPK