Provider Demographics
NPI:1891809869
Name:DANA JO GOVE
Entity Type:Organization
Organization Name:DANA JO GOVE
Other - Org Name:SOUTH VALLEY PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVE
Authorized Official - Suffix:
Authorized Official - Credentials:BS OF SCIENCE
Authorized Official - Phone:408-847-6160
Mailing Address - Street 1:7496 EIGLEBERRY ST
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5712
Mailing Address - Country:US
Mailing Address - Phone:408-847-6160
Mailing Address - Fax:408-847-7878
Practice Address - Street 1:7496 EIGLEBERRY ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5712
Practice Address - Country:US
Practice Address - Phone:408-847-6160
Practice Address - Fax:408-847-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CAPHY475403336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA475400Medicaid
2103346OtherPK