Provider Demographics
NPI:1720148364
Name:VALENCIA TOWN CENTER PHARMACY, INC
Entity Type:Organization
Organization Name:VALENCIA TOWN CENTER PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:BALTHASAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:661-291-1800
Mailing Address - Street 1:26357 MCBEAN PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4491
Mailing Address - Country:US
Mailing Address - Phone:661-291-1800
Mailing Address - Fax:661-291-1801
Practice Address - Street 1:26357 MCBEAN PKWY STE 140
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-4491
Practice Address - Country:US
Practice Address - Phone:661-291-1800
Practice Address - Fax:661-291-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY472353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy