Provider Demographics
NPI:1821115320
Name:NORTH CHESTER PHARMACY LLC
Entity Type:Organization
Organization Name:NORTH CHESTER PHARMACY LLC
Other - Org Name:NORTH CHESTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/CFO/SECRETARY/DIRECTO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAHMAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:VALIVETI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:661-399-3337
Mailing Address - Street 1:1822 N CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-2565
Mailing Address - Country:US
Mailing Address - Phone:661-399-3337
Mailing Address - Fax:661-399-2926
Practice Address - Street 1:1822 N CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-2565
Practice Address - Country:US
Practice Address - Phone:661-399-3337
Practice Address - Fax:661-399-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY498963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126717OtherPK