Provider Demographics
NPI:1720202237
Name:DANVILLE PHARMACY INC
Entity Type:Organization
Organization Name:DANVILLE PHARMACY INC
Other - Org Name:DANVILLE SAN RAMON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PIC
Authorized Official - Prefix:
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:HADJIGHAFOURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-323-9958
Mailing Address - Street 1:905 SAN RAMON VALLEY BLVD STE 106
Mailing Address - Street 2:STE 106
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4035
Mailing Address - Country:US
Mailing Address - Phone:925-820-4603
Mailing Address - Fax:
Practice Address - Street 1:905 SAN RAMON VALLEY BLVD STE 106
Practice Address - Street 2:STE 106
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4035
Practice Address - Country:US
Practice Address - Phone:925-820-4603
Practice Address - Fax:925-820-4604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CAPHY508683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134573OtherPK