Provider Demographics
NPI:1811090160
Name:HAPPY VALLEY PHARMACY LLC
Entity type:Organization
Organization Name:HAPPY VALLEY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:PULVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:928-927-5300
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:QUARTZSITE
Mailing Address - State:AZ
Mailing Address - Zip Code:85346-0600
Mailing Address - Country:US
Mailing Address - Phone:928-927-5300
Mailing Address - Fax:928-927-5299
Practice Address - Street 1:60 W MAIN ST
Practice Address - Street 2:
Practice Address - City:QUARTZSITE
Practice Address - State:AZ
Practice Address - Zip Code:85346
Practice Address - Country:US
Practice Address - Phone:928-927-5300
Practice Address - Fax:928-927-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0063803336C0003X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0354388OtherNCPDP
2171238OtherPK