Provider Demographics
NPI:1457581365
Name:VALLEY PHARMACY
Entity Type:Organization
Organization Name:VALLEY PHARMACY
Other - Org Name:VALLEY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMGAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GADALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-505-6500
Mailing Address - Street 1:7744 PORT ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3537
Mailing Address - Country:US
Mailing Address - Phone:909-327-8467
Mailing Address - Fax:623-505-6505
Practice Address - Street 1:2960 N LITCHFIELD RD STE 120
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7822
Practice Address - Country:US
Practice Address - Phone:623-505-6500
Practice Address - Fax:623-505-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0051723336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0356243OtherNCPDP PROVIDER IDENTIFICATION NUMBER